Pathology testing in the tired patient--a rational approach

Pathology tests are often ordered by general practitioners to investigate patients with nonspecific complaints such as malaise and tiredness.

This article looks at the tests ordered regularly by GPs to investigate tiredness, the value of these tests, and why these tests are ordered in general practice.

General practitioners investigate about half of all tired patients, and most commonly on the first encounter. Tiredness accounts for 4.6% of pathology tests and 2.3% of the growth in pathology testing requested by GPs. Typical pathology tests requested in this circumstance are FBC, EUC, TSH, ferritin and LFTs. Investigations are usually performed to exclude diagnosis and reassure the patient. However, these tests have a low pick up rate of serious disease. More research is needed to establish best practice in the investigation of the tired patient. Future evidence based guidelines should be simple, evidence based and targeted at the general practice experience of patient care.