Thread by @Dr_Hempenstall

1/ Fatigue in Primary Care

It’s that time of year, many of us (myself included!) feel fatigued 🥱

Fatigue is one of the most common presentations in #PrimaryCare yet can be challenging to investigate & manage 🤔

Here’s a #tweetorial on an approach to fatigue 😴

#MedTwitter

2/ Intended Learning Outcomes

💡To recognise fatigue red flags

💡To develop a diagnostic approach to fatigue

💡To outline a fatigue management plan for those with no red flags

3/ What is fatigue?

‘A state characterised by a lessened capacity/motivation for work usually accompanied by feeling weary🥱, sleepy😴, or a loss of ambition😔’

Fatigue is the most common unexplained complaint in #PrimaryCare, but remember it’s a symptom, not a diagnosis!

4/ Causes of Fatigue

Endless! Try Murtagh’s diagnostic framework to list some:

💁🏻‍♀️Probable diagnoses:
Stress, anxiety, depression, viral infections, sleep disorders

🙆🏻‍♀️Serious diagnoses:
malignancy, arrhythmias, HIV

🤦🏻‍♀️Often missed:
Coeliac disease, pregnancy, renal failure

5/ Investigating Fatigue

🤔Did you know 53% of patients who present to their GP with fatigue are investigated

🔬But only 3% have a significant clinical diagnosis based on abnormal pathology

🧪Most tests do not yield a significant clinical diagnosis

ncbi.nlm.nih.gov/pubmed/12973880

6/ Fatigue Red Flags

🚩Recent onset of fatigue in a previously well older patient
🚩Unintentional weight loss
🚩Abnormal bleeding
🚩Short of breath
🚩Unexplained lymphadenopathy
🚩Fever
🚩Recent onset of cardio, gastro, neuro, rheum symptoms

✅Red flags require investigation

7/ What about Patients with NO 🚩Red Flags?

✅Lifestyle advice

✅1-month watchful waiting

✅Try a fatigue management plan

racgp.org.au/afp/2014/july/… @RACGP

8/ Fatigue Management Plan

☕️Reduce your caffeine

🏄🏽‍♀️Get enough exercise

🍷Reduce alcohol intake

😴Practice good sleep hygiene

💊Manage your medications with your GP

📝Be realistic about what you can achieve in a day

Check out @NPSMedicineWise:
activities.nps.org.au/nps-order-form…

9/ Don’t forget about your own fatigue & burnout!
#MedTwitter #MentalHealthMatters

10/ Take Home Messages:

Fatigue requires a comprehensive history & examination. In the absence of red flags, consider judicious use of investigations & a period of watchful waiting.

11/ Check our more here:
📌bmj.com/content/341/bm…
📌learn.nps.org.au/mod/page/view.…
@bmj_latest @NPSMedicineWise