Butler, C, Rollnick, S · Family practice · 1996 · DOI
This study examines a conversation between a doctor and a patient who believed they had ME/CFS. Even though the doctor tried to listen carefully, they didn't fully understand what the diagnosis meant to the patient. The study shows that when doctors don't truly understand what patients mean by their diagnosis, it can damage trust and may slow recovery. The authors suggest that doctors should use reflective listening—repeating back what they hear—to make sure they really understand what patients are experiencing.
This study highlights a critical gap in ME/CFS care: many patients self-diagnose based on their own understanding of their symptoms, but clinicians may misinterpret what patients mean by the diagnosis label. Better communication between patients and healthcare providers could improve trust, treatment adherence, and potentially clinical outcomes. For ME/CFS patients—who often face skepticism—being truly heard by their doctor is essential to meaningful care.
This single case study cannot establish whether improved doctor-patient communication directly improves ME/CFS recovery rates or outcomes. It does not prove that all misunderstandings in ME/CFS consultations follow this pattern, nor does it demonstrate that reflective listening would be effective in clinical practice without further testing. The study is illustrative rather than definitive evidence of causation.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Butler, C & Rollnick, S (1996). Missing the meaning and provoking resistance; a case of myalgic encephalomyelitis.. Family practice. https://doi.org/10.1093/fampra/13.1.106
BibTeX
@article{mecfsatlas-butler-1996-missing-meaning,
author = {Butler, C and Rollnick, S},
title = {Missing the meaning and provoking resistance; a case of myalgic encephalomyelitis.},
journal = {Family practice},
year = {1996},
doi = {10.1093/fampra/13.1.106},
note = {PubMed: 8671111},
url = {https://www.mecfsatlas.com/evidence/butler-1996-missing-meaning},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-25. https://www.mecfsatlas.com/evidence/butler-1996-missing-meaning
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