Fatigue: let's talk about it

R. L. Lambson, Newcastle medical student, currently intercalating (Mres)
doi:10.7244/cmj.2015.06.002


Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a debilitating condition characterised by intense long-lasting fatigue and affects 0.2-2% UK population. In addition, a more significant burden to UK health is the fatigue is commonly associated with many chronic diseases. Over 17.5 million people within the UK currently suffer with a chronic disease (1), a figure which is set to rise with the aging population. Those with an attributable cause for their fatigue, such as chronic diseases, are unable to access NHS CFS services. Despite this, NHS services dedicated to the fatigue occurring outside CFS/ME are lacking. This leaves many people without the support and access to the multidisciplinary team that they need.

Currently, fatigue does not seem to be a priority in patient care and many doctors do not appear to focus on tackling fatigue, as illustrated by the minimal NHS provision outside of CFS/ME services. This could be because it does not fit into traditional medical specialties, it is subjective and undefined, and there is often no cure. So why bother? All too often, patients are shifted from one doctor to another with nobody taking the responsibility of tacking their fatigue. It is as though nobody wants the hassle.

As a medical student I have a unique opportunity to observe different medical teams in operation. One thing that strikes me from my experiences is the rarity of a doctor who gives the time to sit down and listen to their patient’s concerns. All too often a brisk interview is conducted whereby the patient can be left looking bewildered and without a discussion of their main concerns. Whilst it must be acknowledged that doctors are under intense time pressures, I argue that a simple reflective and empathetic question enabling the patient to voice their concerns will add minimally to the appointment time. Moreover, it is likely to reduce further appointment due to dissatisfaction with the consultation (2).

When a patient expresses that they are fatigued, we should not dismiss it, thinking to ourselves “aren’t we all tired?”. Intense fatigue is so severe it can cloud patients’ concentration; they may withdraw from social circles as it is too exhausting to be a part of, and they can find simple daily tasks like climbing the stairs challenging. These patients have a different level of fatigue to what most of us have experienced and can appreciate. Having had the privilege to sit and listen to many patients at a fatigue clinic I am based at, and to show my concern at what they experience, it is something they appear to value very highly. Obviously, most doctors will not have the same amount of time to give. However, it does not take much extra time to simply ask how the patient is feeling. When did you last ask that to a patient? Whilst it is something I feel is one of the joys of being a medical student, I would hope I would continue to have a personal approach to consultations once I am practicing because I have seen how much a patient can benefit from this.

Whilst I have argued that fatigue in general is not supported satisfactorily, and targeted service provision like in CFS/ME is needed, the attitudes towards CFS/ME are still far behind where they should be. The lack of respect for CFS/ME within some of the medical profession infuriates me (3). I am often met with derogatory and dismissive views about CFS/ME. Whilst I acknowledge the profession has come a long way to accepting the illness I believe it still has a way to come. Not that long ago I had a relatively heated discussion with a young anaesthetics trainee regarding their belief of its factitious nature. Evidence for the biological basis of CFS/ME is increasing all the time (4), and, regardless of this we can observe the many hundreds of people who suffer with it and whose lives are ruined by it. For these patients, it would be ludicrous to suggest it was factitious. What would they possibly gain from a diagnosis which has nothing much but stigma attached to it? It is time we as a profession began to accept and believe our patients. I am embarrassed by the views held by some within the medical profession who continue to breed this ethos within us. If we, as doctors, do not respect and believe our patients who can they expect to listen to them? I personally do not see what is gained by having this disparaging attitude towards CFS/ME, other than to give us a judgemental appearance to the people we want to respect us the most.

I am proud to be working in the area of disease-related-fatigue this year because I can see the value this patient group has for the fatigue clinic I am based in. I want more people to see how rewarding working in this neglected area can be because it desperately needs committed medical multidisciplinary teams to engage.

Next time a patient comes in to your clinic complaining of tiredness; please take a moment to explore it, to help find a solution, but if nothing else listen to them. Show your human touch. It is not rocket science.

Conflict of interest: None declared

1. Improving chronic disease management. Department of Health. 2004.

2. Relationship between patient satisfaction with inpatient care and hospital readmission within 30 days. Boulding W, Glickman SW, Manary MP, Schulman KA, Staelin R. 1, s.l. : Am J Manag Care., 2011, Vol. 17. PubMed PMID: 21348567..

3. Views on the nature of chronic fatigue syndrome: content analysis. White, Zahra Hossenbaccus and Peter D. 4, s.l. : JRSM Short Reports , 2013, Vol. 4. doi:10.1258/shorts.2012.012051.

4. Distinct plasma immune signatures in ME/CFS are present early in the course of illness. Mady Hornig, José G. Montoya, Nancy G. Klimas, Susan Levine. 1, s.l. : Science Advances, 2015, Vol. 1.