title: Investigation of fatigue by Australian general practice registrars: a cross-sectional study.
abstract: BACKGROUND
  Fatigue is the most common undifferentiated problem presenting in general practice. Previous studies have shown that this presentation leads to multiple investigations. There is no published literature describing the management of patients with fatigue by general practice (GP) registrars.
  
  
  OBJECTIVE
  To document the investigation-ordering behaviour of GP registrars in managing patients with a new diagnosis of unexplained fatigue.
  
  
  METHODS
  This was a cross-sectional analysis of data from Registrar Clinical Encounters in Training (ReCEnT), an ongoing cohort study of GP registrars' consultations. We established the prevalence of new diagnoses of unexplained fatigue and associations with that diagnosis, the rate of test ordering and the number and types of investigations ordered.
  
  
  RESULTS
  644 registrars contributed data from 68 986 encounters. In 0.78% of patient encounters, a new diagnosis of unexplained fatigue was made. Pathology was ordered in 78.4% of these problems (versus 18.1% in non-fatigue problems), at a rate of 488 tests per 100 new fatigue problems.
  
  
  CONCLUSIONS
  Our study suggests that unexplained fatigue elicits a non-rational approach to test ordering by registrars. These findings contribute to the understanding of GP registrar management of fatigue, and undifferentiated presentations more broadly, and suggest educational approaches to improve practice, including dealing with uncertainty.
authors.affiliation: General Practice Training Valley to Coast, Newcastle, Australia. simon.morgan@gptvtc.com.au.
authors.forename: Simon
authors.initials: S
authors.lastname: Morgan
authors.affiliation: General Practice Training Valley to Coast, Newcastle, Australia.
authors.forename: Kim M
authors.initials: KM
authors.lastname: Henderson
authors.affiliation: General Practice Training Valley to Coast, Newcastle, Australia.
authors.forename: Amanda
authors.initials: A
authors.lastname: Tapley
authors.affiliation: General Practice Training Valley to Coast, Newcastle, and Discipline of General Practice, University of Newcastle, Newcastle, Australia.
authors.forename: Allison
authors.initials: A
authors.lastname: Thomson
authors.affiliation: General Practice Training Valley to Coast, Newcastle, Australia.
authors.forename: Jessica
authors.initials: J
authors.lastname: Wilson
authors.affiliation: General Practice Training Valley to Coast, Newcastle, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Scott
authors.affiliation: Victorian Metropolitan Alliance General Practice Training, and Department of General Practice, University of Melbourne, Melbourne, Australia.
authors.forename: Neil A
authors.initials: NA
authors.lastname: Spike
authors.affiliation: Adelaide to Outback GP Training Program, Adelaide, Australia.
authors.forename: Lawrie
authors.initials: L
authors.lastname: McArthur
authors.affiliation: Discipline of General Practice, University of Queensland, Brisbane, Australia.
authors.forename: Mieke L
authors.initials: ML
authors.lastname: van Driel
authors.affiliation: General Practice Training Valley to Coast, Newcastle, and Discipline of General Practice, University of Newcastle, Newcastle, Australia.
authors.forename: Parker J
authors.initials: PJ
authors.lastname: Magin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D005221:Fatigue / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D058005:General Practitioners; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult