title: Fatigue as a first-time presenting symptom: management by family doctors and one year follow-up.
abstract: BACKGROUND
  Fatigue is a common complaint in primary care and has a broad differential diagnosis, making the approach complex and often ineffective.
  
  
  OBJECTIVE
  To follow the course of adults without a significant known background disease who complain of fatigue for the first time, and to characterize the family physician's approach.
  
  
  METHODS
  The study population comprised a random sample of 299 patients aged 18-45 who presented with fatigue as a first-time single complaint to their family physician. Excluded were patients with chronic diseases or states that may include signs of fatigue. We analyzed the index encounter data, the diagnostic and laboratory tests, the medications prescribed and the one year clinical outcome.
  
  
  RESULTS
  Seventy percent were women, average age 30.5 years, and 69% had no known co-morbidities; 57% of the patients were physically examined at the first visit and most (78.6%) were sent for laboratory analysis. Five percent of laboratory tests were positive. Eighty patients (26.8%) were given a specific diagnosis, with the leading diagnoses being anemia and infectious diseases; 18.7% were given sick leave at the first visit. Fatigue was more common in early summer.
  
  
  CONCLUSIONS
  The majority of young healthy patients complaining of fatigue are not diagnosed with an organic physiological disorder. Many of the study patients were sent for laboratory tests but in most cases these tests were not contributory to the diagnosis or management. It seems likely that the most efficient strategy would be watchful follow-up with a minimum of testing.
authors.affiliation: Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors.forename: Eliezer
authors.initials: E
authors.lastname: Kitai
authors.forename: Gari
authors.initials: G
authors.lastname: Blumberg
authors.forename: David
authors.initials: D
authors.lastname: Levy
authors.forename: Avivit
authors.initials: A
authors.lastname: Golan-Cohen
authors.forename: Shlomo
authors.initials: S
authors.lastname: Vinker
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D003937:Diagnosis, Differential; D003955:Diagnostic Tests, Routine; D005221:Fatigue / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012307:Risk Factors