Evaluation and management of fatigue

Fatigue is a common symptom among patients of primary care physicians. For many physicians and patients, interactions related to the subject of fatigue are frustrating and unsatisfying, because of differences in expectations, a narrow focus on biomedical origins or solutions, and failure to include psychosocial issues in evaluation and management. The initial office visit should focus on the patient's history, to determine the type of fatigue and establish an effective therapeutic relationship. Few, if any, laboratory tests should be ordered. The second office visit should be used to review the information collected, add any new information from the patient's diary or reports from the patient's significant others, and perform a complete physical examination. Patients whose fatigue is diagnosed as physiologic or secondary to a medical problem should receive specific therapeutic interventions. The management of other patients requires interventions that combine biomedical and psychosocial therapies with a commitment to long-term follow-up. The key to successful management of fatigue is an effective therapeutic relationship with the patient.