Twemlow, S W, Bradshaw, S L, Coyne, L et al. · Psychological reports · 1997 · DOI
This study surveyed 609 people with ME/CFS to understand how their relationships with doctors differ from those of other patients with medical conditions. People with ME/CFS reported missing about 65 days of work per year due to illness, experienced more side effects from medical treatments, spent more money on healthcare, and visited more specialists than patients with typical medical conditions. The researchers found that doctors may need to pay more attention to how ME/CFS patients perceive their illness and their doctor-patient relationship, as these beliefs can affect how well treatments work.
This study documents the substantial functional impact and healthcare burden experienced by ME/CFS patients compared to other chronically ill populations, highlighting a critical gap in patient-centered care. By identifying that doctor-patient relationship dynamics significantly influence treatment outcomes, the research supports the need for improved clinical communication and psychological awareness in ME/CFS management. Understanding these patterns may help clinicians provide more effective and appropriate care for this severely affected population.
This study cannot establish causality—it does not prove that poor doctor-patient relationships cause worse ME/CFS outcomes, only that they co-occur. The cross-sectional design prevents determining whether patient perceptions shape doctor behavior or vice versa. The study relies on self-reported diagnosis without independent clinical confirmation, so findings may not apply to all ME/CFS patients or may include misdiagnosed cases. Self-reported iatrogenic illness cannot verify whether medical complications actually resulted from doctor-prescribed treatments or patient attributions.
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
Twemlow, S W, Bradshaw, S L, Coyne, L, & Lerma, B H (1997). Patterns of utilization of medical care and perceptions of the relationship between doctor and patient with chronic illness including chronic fatigue syndrome.. Psychological reports. https://doi.org/10.2466/pr0.1997.80.2.643
BibTeX
@article{mecfsatlas-twemlow-1997-patterns-utilization,
author = {Twemlow, S W and Bradshaw, S L and Coyne, L and Lerma, B H},
title = {Patterns of utilization of medical care and perceptions of the relationship between doctor and patient with chronic illness including chronic fatigue syndrome.},
journal = {Psychological reports},
year = {1997},
doi = {10.2466/pr0.1997.80.2.643},
note = {PubMed: 9129381},
url = {https://www.mecfsatlas.com/evidence/twemlow-1997-patterns-utilization},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/twemlow-1997-patterns-utilization
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