This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (11)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Musculoskeletal Syndromes (Chronic Fatigue, Gulf War)  • Alert me on articles by topic  Social Bookmarking   What's this?

Ralph D. Richardson, PhD; Charles C. Engel, Jr, MD, MPH; Miles McFall, PhD; Katherine McKnight, PhD; James K. Boehnlein, MD; Stephen C. Hunt, MD

Arch Intern Med. 2001;161:1289-1294.

Background  Several clinical syndromes are defined solely on the basis of symptoms, absent an identifiable medical etiology. When evaluating and treating individuals with these syndromes, clinicians' beliefs might shape decisions regarding referral, diagnostic testing, and treatment. To assess clinician beliefs about the etiology and treatment of "Gulf War illness," we surveyed a sample of general internal medicine clinicians (GIMCs) and mental health clinicians (MHCs).

Methods  Clinicians (77 GIMCs and 214 MHCs) at the Veterans Affairs Puget Sound Health Care System, Seattle, Wash, and the Veterans Affairs Medical Center in Portland, Ore, responded to a mailed survey of their beliefs about Gulf War illness.

Results  Compared with GIMCs, MHCs were more likely to believe that Gulf War illness was the result of a "physical disorder" and that symptoms resulted from viruses or bacteria, immunizations, exposure to toxins, chemical weapons, or a combination of toxins and stress (P < .05). Conversely, GIMCs were more likely than MHCs to believe that Gulf War illness was a "mental disorder" and that symptoms were due to stress or posttraumatic stress disorder (P < .05). In addition, MHCs were more likely to endorse biological interventions to treat Gulf War illness (P < .01), whereas GIMCs were more likely to endorse psychological interventions.

Conclusions  Clinicians' beliefs about the etiology and effective treatment of Gulf War illness vary and thus might contribute to the multiple referrals often reported by Gulf War veterans. Health care models for Gulf War veterans and others with symptom-based disorders necessitate collaborative interdisciplinary approaches.

From the Veterans Affairs Puget Sound Health Care System, Seattle, Wash (Drs Richardson, McFall, and Hunt); the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Drs Richardson and McFall); the Department of Psychiatry, Uniformed Services University, Bethesda, Md (Dr Engel); Deployment Health Clinical Center, Walter Reed Army Medical Center, Washington, DC (Dr Engel); the Department of Psychology, University of Arizona, Tucson, and the Center for Excellence, Substance Abuse Treatment, Veterans Affairs Puget Sound Health Care System (Dr McKnight); and the Veterans Affairs Medical Center, Portland, Ore (Dr Boehnlein).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Negotiating the diagnostic uncertainty of contested illnesses: physician practices and paradigms
Swoboda
Health (London) 2008;12:453-478.
ABSTRACT  

Health Care Professionals' Beliefs About Gulf War Illness
JWatch Psychiatry 2001;2001:7-7.
FULL TEXT  

Health Care Professionals' Beliefs About Gulf War Illness
JWatch General 2001;2001:3-3.
FULL TEXT