Fatigue: a rational approach to investigation

Background: Fatigue is a common reason for presentation to the general practitioner. There is a wide range of possible diagnoses, some potentially serious, but somatic pathology is uncommon. Presentations of fatigue lead to high rates of test ordering, but abnormal results leading to significant diagnoses are uncommon. A number of guidelines for the assessment and investigation of fatigue have been developed, including in Australia. Objective: The objective of this article is to outline a rational approach to the investigation of fatigue, informed by the international literature and recently published Australian guidelines. Discussion: On the basis of current literature, we recommend the following practical approach to the patient presenting with fatigue: a comprehensive history and examination, consideration of a period of watchful waiting in the absence of red flags and judicious use of tests once the decision to investigate is made.