Evaluating the complaint of fatigue in primary care: diagnoses and outcomes

This case series describes associated diagnoses and prognoses of persistent fatigue in a community-based, primary care population.

All patients presenting to a private practice internist with a chief complaint of fatigue of more than 1 month's duration were prospectively evaluated with clinically directed examination and diagnostic testing. Patients were excluded if they had a previously diagnosed illness associated with fatigue. Fatigue was attributed to newly established diagnoses or medication use based on explicit criteria. Change in the state of each patient's fatigue was measured 6 months after entry.

Fifty-two consecutive patients entered the study. The diagnoses associated with fatigue were a medical disorder in 25 patients, depression in 10 patients, and no definitive diagnosis in 18 patients. The mean cost of diagnostic testing was $131. At 6 months, 37 of 52 patients (72%) reported improvement in or resolution of their fatigue.

In a primary care setting, many patients presenting with persistent fatigue have an associated, treatable disease that can be determined using a cost-effective, clinically directed approach. Most will experience an improvement in their fatigue.