This article illustrates that the diagnostic evaluation as well as
the management of the patient presenting with chronic fatigue
can be done in an orderly manner. If a medical illness is the
cause of the patient's fatigue, this is usually evident on
initial presentation. A thorough history and complete physical
examination, in conjunction with some screening laboratory
tests, can rule out most medical causes of fatigue, and any
remaining cases declare themselves over the next several
visits. If a medical cause is not evident, a further "fishing
expedition" is fruitless.
Psychiatric illness, such as depression or generalized anxiety disorder,
accounts for another significant proportion of cases of chronic fatigue.
As with medical illness, psychiatric illness should be suspected
based on history and is not a diagnosis of exclusion. Some
patients presenting with chronic fatigue have a history and
symptom pattern consistent with the diagnosis of CFS. The
cause of this syndrome is controversial and is still unknown.
The clinician, however, can offer the patient care in an
environment that is respectful of their physical and
psychological discomfort and can provide significant
symptomatic improvement to the patient. Lastly, some patients
with fatigue do not fit any diagnostic category, including
CFS. As with many other common complaints, such as headaches
or abdominal pain, although a diagnosis may not be given to
the patient, the clinician can do a lot to reassure the
patient and assist the patient in living with his or her
symptoms. As Solberg eloquently wrote: "[E]valuation of the
fatigued patient requires all of a physician's best
attributes–a broad view of disease, psychosocial sensitivity,
and a good ongoing relationship with the patient."