History of tiredness

Mr Smith has come to see you. He is a twenty-nine year old architect who has been feeling
tired for the last two months. Take a history from him and explain the management. This
scenario is about finding the cause of chronic tiredness and counselling regards to chronic
fatigue syndrome.

Always introduce yourself to the patient and shake his hands to greet him.

Ask him what you can do for him: ‘Hello, Mr Smith, my name is Dr Jones, what may I do for
you?’

1) Take a history about his symptoms.

How long have you been feeling tired for?

Are you tired all the time, or does it follow some pattern?
Do you have any other symptoms with the tiredness, like muscle aches?
Are you normally well?
Do you take any medications?
Do you smoke? Do you take alcohol?
Have you had a cold recently?
2) Ask specific questions about causes of tiredness:

Thyroid: Have you been putting weight on recently? Do you feel cold when others in the room
feel warm? How are your bowels? How are your periods? (if patient is a woman).
Anaemia: Have you been losing any blood from anywhere - such as your bowels, vomiting or
waterworks?
Renal Problems: Are your waterworks normal? Have you been feeling sick?
Malignancy: Have you lost any weight or been having any night-sweats?
Depression: How has your mood been recently? Have you been sleeping and eating properly?
3) Explain the diagnosis to the patient.

Mr Smith, after talking to you I can rule out most of the serious causes of tiredness. However, I
would like to examine you and do some blood tests (see below). I think you may have
something called chronic fatigue syndrome. Do you know anything about this?

Well, chronic fatigue syndrome is a condition in which you can feel extremely tired and also
have aches and pains. It is quite common nowadays. We don’t know exactly what causes it but
it may be related to an infection. Unfortunately, there is no blood test to diagnose it and there
is no cure. But the good news is that it gets better itself over time in most people. There are
some treatments that can help some. I will explain them to you.

4) Explain management to patient.

As I have said earlier there is no cure but some treatments can help. There are mainly a few
options a) Cognitive Behavioural Therapy - I can refer you to a specialist counsellor who will
talk to you and try and help you. He will help you modify your thinking and help you think more
positively about your condition.

(b) Pacing - here we will teach you to adjust your activity depending on how you feel. For
example if you feel very well one day then you can increase your activity. If on the other hand
you feel tired, then take it easy that day.

(c) Graded Exercises - here you try to increase your activity slowly over days. That is everyday
you try and do slightly more than the previous day. Once you feel tired just stop and rest. That
way we will be able to increase your activity. Don’t do too much because that will just cause
more tiredness.

(d) Antidepressants - in some people antidepressant tablets help. I am not saying that you are
depressed but these tablets can sometimes help. They are not addictive but take a few weeks
to start working.

5) Close

Do you understand all this Mr Smith? I can give you a leaflet about this and there are some
societies I can give you details for.