Fatigue

Conduct a patient-centred interview to
- Define what the patient means by “fatigue” and distinguish it from other concerns e.g. mood concerns, muscle weakness, decreased exercise tolerance.
- Identify clinical symptoms/red flags that suggest a secondary etiology, e.g. depression, anemia, hypothyroidism, malignancy, sleep apnea, cardiac disease.
- Identify the social determinants of health that may suggest psychosocial concerns and impact differential diagnosis and/or management, e.g. Homelessness, isolation, single parent, addiction, recent losses, sleep quality/shift work.

Conduct a relevant physical exam to refine different diagnosis.
Propose initial investigations based upon differential diagnosis, while avoiding over-investigation
Develop a management plan based upon the clinical scenario and results of initial investigations
Understand when to include “watchful waiting” as an appropriate diagnostic and/or management tool.

Articles

Miller M, Clarkson B. Fatigue One-Page Primer. DFCM Open. 2013. Available at: http://dfcmopen.com. Attribution CC BY-NC-ND

Cornuz J, Guessous I, Favrat B. Fatigue: A practical approach to diagnosis in primary care. CMAJ. 2006;174(6):765-767. doi: 174/6/765 [pii].

Rosenthal TC, Majeroni BA, Pretorius R, Malik K. Fatigue: An overview. Am Fam Physician. 2008;78(10):1173-1179.