Review Fatigue as the Chief Complaint: Epidemiology, Causes, Diagnosis, and Treatment 2021 Maisel et al

Background: Fatigue is a main or secondary reason for 10–20% of all consultations with a primary care physician.

Methods: This review is based on pertinent publications retrieved by a comprehensive, selective literature search on the epidemiology, etiology, and diagnostic evaluation of fatigue as a leading symptom of disease, as well as on the treatment of its common causes. Information was also included from the literature search we conducted for the German clinical practice guideline on fatigue that was issued by the German College of General Practitioners and Family Physicians (Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin, DEGAM).

Results: Fatigue can be due to any of a broad spectrum of diseases, including decompensation of already known conditions. Sleep disorders and sleep-related disorders of breathing, depression (18.5%), and excessive psychosocial stress are the most common causes of persistent fatigue. Previously undiagnosed cancer is a rare cause, accounting for only 0.6% of cases (95% confidence interval [0.3; 1.3]). Anemia and other organic causes are rare as well (4.3% [2.7; 6.7]). Investigations beyond the history, physical examination, and simple laboratory tests are needed only in the presence of additional symptoms or findings. If the diagnosis remains unclear, watchful waiting and regularly scheduled follow-up help prevent an excessive focus on somatic causes, leading to overdiagnosis. Irrespective of specific causes, psychoeducative and psychotherapeutic approaches should be discussed with the patient, as well as an individually adapted exercise program.

Conclusion: The work-up of fatigue as a chief complaint should be guided by investigating common and/or potentially dangerous disorders. Since the latter are rare, an exclusively somatic focus should be avoided in order to prevent overdiagnosis.

Open access, https://www.aerzteblatt.de/int/archive/article/220820

 

From the article: "Anemia and other organic causes are rare as well." Dismissing the possibility that fatigue could be caused by anemia because it's assumed to be rare is concerning.

Regarding the prevalence of anemia, the World Health Organization calls it a "major public health concern":

Key facts

• Anemia is major public health concern, mainly affecting young children, pregnant and postpartum women, and menstruating adolescent girls and women.
• Low- and lower-middle income countries bear the greatest burden of anaemia, particularly affecting populations living in rural settings, in poorer households and who have received no formal education.
• Globally, it is estimated that 40% of all children aged 6–59 months, 37% of pregnant women and 30% of women 15–49 years of age are affected by anaemia.
• Anaemia caused 50 million years of healthy life lost due to disability in 2019. The largest causes were dietary iron deficiency, thalassaemia and sickle cell trait, and malaria (1).

https://www.who.int/news-room/fact-...is estimated that,age are affected by anaemia.


And, in Canada: "Total population uncorrected prevalence estimates were 7%..." from:
Population Iron Status in Canada: Results from the Canadian Health Measures Survey 2012–2019

https://www.sciencedirect.com/science/article/pii/S0022316623354804

 

So much for the concept of differential diagnosis. What happened to doctoring in the investigatory sense?

What am I paying them to do, or not to do, because they get my money regardless?

 

Hypothyroidism is another disease that causes fatigue.

According to "Hypothyroidism in Context: Where We’ve Been and Where We’re Going", "Hypothyroidism
affects up to 5% of the general population, with a further estimated 5% being undiagnosed.":

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6822815/#:~:text=Hypothyroidism affects up to 5,patients suffer from primary hypothyroidism

There is a long list of diseases that negatively affect energy. Are we to throw traditional medical practice out the window in favour of the myopic BPS view of ill health? Definitely not.