Tired all the time: can new research on fatigue help clinicians?

Abstract

Over 10% of patients attending primary care clinics describe at least one month of substantial fatigue.1 Despite its prevalence, many clinicians feel uncertain or dissatisfied with the level of care they are able to provide patients with persistent fatigue.2 These anxieties are not without basis; up to two-thirds of patients with chronic fatigue report being dissatisfied with the quality of care they receive.3 GPs will tend to stereotype patients with chronic fatigue as having certain undesirable traits and will feel a sense of hopelessness regarding treatment options.4 However, there is now an emerging body of research evidence which should provide GPs with a greater sense of certainty regarding their management decisions. Incorporating this evidence base into clinical practice should allow clinicians to feel less helpless, and will hopefully result in improved outcomes for patients suffering from the debilitating effects of fatigue. One of the main anxieties when managing a complaint of fatigue is how to begin and when to end investigations aimed at identifying any underlying physical disease. This difficulty stems from fatigue being a very non-specific symptom, with very low yields from any particular investigation. There are, however, numerous cautionary tales of individuals who have suffered from delayed or missed diagnoses due to under investigation of fatigue.5 A previous study based in the US demonstrated that even in a specialised clinic, only 2% of examinations provided diagnostic information, and laboratory investigations revealed an underlying cause in only 5% of patients.6 However, fatigued patients seen in specialised clinics are different from those seen in general practice,7 with some reports suggesting that …