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The 'Oslo Chronic Fatigue Consortium' consists of researchers and clinicians who question the current narrative that chronic fatigue syndromes, including post-covid conditions, are incurable diseases. Instead, we propose an alternative view, based on research, which offers more hope to patients. Whilst we regard the symptoms of these conditions as real, we propose that they are more likely to reflect the brain's response to a range of biological, psychological, and social factors, rather than a specific disease process. Possible causes include persistent activation of the neurobiological stress response, accompanied by associated changes in immunological, hormonal, cognitive and behavioural domains. We further propose that the symptoms are more likely to persist if they are perceived as threatening, and all activities that are perceived to worsen them are avoided. We also question the idea that the best way to cope with the illness is by prolonged rest, social isolation, and sensory deprivation. Instead, we propose that recovery is often possible if patients are helped to adopt a less threatening understanding of their symptoms and are supported in a gradual return to normal activities. Finally, we call for a much more open and constructive dialogue about these conditions. This dialogue should include a wider range of views, including those of patients who have recovered from them. [ABSTRACT FROM AUTHOR]

Background: Doctors' ability to communicate with patients varies. Patient questionnaires are often used to assess doctors' communication skills. Objective: To investigate whether the Four Habits Patient Questionnaire (4HPQ) can be used to assess the different skill levels of doctors. Design: A cross-sectional study of 497 hospital encounters with 71 doctors. Encounters were videotaped and patients completed three post-visit questionnaires. Setting: A 500-bed general teaching hospital in Norway. Main outcome: The proportion of video-observed between-doctor variance that could be predicted by 4HPQ. Results: There were strong correlations between allpatient-reported outcomes (range 0.71-0.80 at the doctor level, p<0.01). 4HPQ correlated significantly with video-observed behaviour at the doctor level (Pearson's r=0.42, p<0.01) and the encounter level (Pearson's r=0.27, p<0.01). The proportion of between-doctor variance not detectable by 4HPQ was 88%. The reason for this discordance was large withindoctor between-encounter variance observed in the videos, and small between-patient variance in patient reports. The maximum positive predictive value for the identification of poorly performing doctors (92%) was achieved with a cut-off score for 4HPQ of 82% (ie, patient assessments were concordant with expert observers for these doctors). Conclusion: Using a patient-reported questionnaire of doctors' communication skills, favourable assessments of doctors by patients were mostly discordant with the views of expert observers. Only very poor performance identified by patients was in agreement with the views of expert observers. The results suggest that patient reports alone may not be sufficient to identify all doctors whose communication skills need improvement training. [ABSTRACT FROM AUTHOR]

Background: There is a paucity of research on clinical communication in hospitals. A large Norwegian hospital has tried out a course (developed in the USA) in clinical communication. In this substudy, we investigated the association between doctors' self-efficacy and participation in this course., Material and Methods: Doctors under 60 years of age, working in clinical somatic departments in Akershus University Hospital, were eligible for inclusion. The participants completed a validated questionnaire before and after the course. Self-efficacy was assessed (on a 10-point scale) through nine important communication skills., Results: 103 doctors (randomly selected) were asked to participate in the study; 62 of them completed the 20-hour course. After completion of the course, the participants were more confident that communication skills could be learnt in this way than they were before it started. Their self-efficacy only improved moderately, on average 0.6 on the 10-point scale, but the change was statistically significant for seven of the nine skills. After completion of the course, self-efficacy had improved for 41 doctors and deteriorated for ten. Nevertheless, the latter were still positive regarding the learning effect of the course. The effects were independent of the doctors' sex, age, position (resident or consultant), self-efficacy before the course, and specialty. Of the skills taught, demonstration of empathy was the one that fewest doctors wanted to practice after the course., Interpretation: A short course in clinical communication skills led to a moderate improvement in the participating doctors' self-efficacy. Whether this change implies improved communication is currently under investigation.