A GP's belief about certain medical conditions may block patients from getting best care, say researchers.
GP's attitude may influence the assessment
By analysing group discussions between 46 UK GPs, they found some tended to stereotype patients with chronic fatigue syndrome as "prone to stress".
In contrast, patients with irritable bowel syndrome were seen to be battling with a debilitating disease.
Such biases could block care, say the Medical Research Council authors in the British Medical Journal.
The 46 GPs studied were asked to discuss a series of clinical scenarios involving patients with irritable bowel syndrome (IBS) or chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis or ME.
They were also asked to rate their level of agreement with certain treatment options.
For example, one scenario concerned the appropriateness of a psychological therapy for a patient who believed their symptoms were due to a physical problem.
CFS was officially recognised as a genuine illness in the UK by the Royal
Colleges of Physicians and General Practitioners in October 1996.
But some of the GPs tended to view patients with CFS as having certain undesirable traits such as being "introspective" or having a "low symptom threshold".
They saw CFS patients as having "a certain personality trait that is chronic
fatigue syndrome waiting to happen".
Rosalind Raine and colleagues suggest the doctors' stereotyping of CFS patients meant they saw the condition less as a discrete disorder, and more as a defining feature of the patient.
Such stereotyping of IBS did not seem to occur.
The study authors suggest one reason why this might be is that it is easier to picture IBS being a physical problem because of it affects a specific part of the body, unlike CFS.
Also, patients with CFS were seen as failing to conform to the work ethic by coping better when avoiding stressful situations, and to be ignoring the normal obligation of the sick role, which is to make every effort to get well as quickly as possible.
In contrast, patients with IBS were viewed to "battle through it" and rarely "debilitated to such an extent that they were off work".
The study authors said GPs' perceptions about patients with certain conditions might prevent them from assessing and treating each patient as objectively as possible.
Barrier to care
"To overcome these barriers, doctors must recognise their deeply held beliefs that mediate their understanding of complex disease mechanisms," they said.
A spokeswoman from Developing Patient Partnerships said: "Good communication between health professionals and patients is very important in any consultation.
"Patients need to feel that they are listened to and GPs need support in ensuring that their patients get the best quality care through easily accessible information on conditions such as CFS and effective communication," she said.
Chris Clark, chief executive of Action for M.E., said he was bitterly disappointed that basic messages about CFS had not got through to GPs.
"We should remember that a substantial number of people do find their GPs understanding and supportive, but it is a cause of great distress that the therapeutic partnership necessary to manage this condition should be blocked by poor understanding.
"Patients need caring, understanding and above all well informed doctors," he said.
Dr Charles Shepherd, from the ME Association said GPs find CFS a difficult condition to manage.
"Conflicts arise, especially when the GP believes it's psychological rather than physical."
He added that the study authors themselves appeared to advocate psychological interventions for ME, which he said was incorrect.
"The view of the WHO and the department of health is that it's a neurological illness," he said.