Chronic fatigue complaints in primary care: incidence & diagnostic patterns

The complaint of chronic fatigue is ubiquitous in the primary care
setting. Because of the nonspecific nature of chronic
fatigue, practitioners do not focus on this complaint.
Furthermore, most physicians use a problem-based approach.
Such a prematurely narrowed focus could overlook the chronic
fatigue complaint. Omissions in the data collection process
would prove this oversight. Therefore, we postulated that a
retrospective review of evaluations for chronic fatigue would
demonstrate significant categorical deficiencies. These
deficiencies would indicate a problem focus different than
the chronic fatigue complaint itself.

The authors reviewed
the current literature to establish historical, physical, and
laboratory findings pertinent to the evaluation of chronic
fatigue. Six major categories and the associated data
elements were identified for use in analyzing patient
records. The patient records from the preceding 6 months were
reviewed to find those containing a complaint of chronic
fatigue. These records were analyzed to determine if a
complete data set had been sought and if an associated
diagnosis was made.A total of 425 consecutive charts from an
academic family practice clinic were retrospectively
reviewed; 9.9% (42) mentioned chronic fatigue. Physicians
were lax in performing the mental status and physical
examinations; taking the patient's psychiatric and sleep
history, as well as the history of chief complaint; and
ordering laboratory evaluations. The physician diagnoses
included: depression (40.4%), nonspecific fatigue(35.7%),
general medical disorders (16.6%), chronic fatigue syndrome
(2.4%), fibromyalgia (2.4%), and sleep apnea (2.4%).

From these data, the investigators conclude that the workup for
chronic fatigue is often incomplete or lacks documentation.
This oversight is likely due to a problem focus not directed
at thechronic fatigue complaints. Also complicating the
evaluation process are the multiple associated disorders, the
prevalence ofthe complaint, and cost/benefit issues facing
the primary carephysician.

Ward MH, DeLisle H, Shores JH, Slocum PC, Foresman BH

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