Fatigue is one of the most common reasons people seek medical help. Yet it remains one of the most misunderstood symptoms: difficult to describe, easy to dismiss, and often oversimplified as “stress” or “just tiredness.” In modern medicine, fatigue is never a trivial complaint. It is a signal — and the role of a primary care physician is to understand what exactly your body is trying to say. At A CLINIC, we use an evidence-based, thoughtful and patient-centered approach to help our patients understand and manage both acute and chronic fatigue.
Fatigue is not a diagnosis — it is a broad, nonspecific symptom. It can manifest in different ways:
- difficulty starting activities
- reduced ability to sustain activity
- cognitive fatigue (poor concentration, memory issues, emotional instability)
- sleepiness or an uncontrollable need to sleep
Many patients experience more than one of these at the same time. Fatigue may appear on its own or along with other symptoms.
Acute vs. Chronic Fatigue
Acute fatigue (up to 1 month)
Most commonly associated with infections, acute illnesses, or recent stressors. In these cases, a detailed history and physical exam are usually all that’s needed.
Subacute and chronic fatigue (1–6 months and longer)
Chronic fatigue can be linked to:
- cardiological, endocrine, pulmonary, hematological, neurological or infectious conditions
- medication side effects
- sleep disorders
- psychological conditions
- prolonged stress
In about two-thirds of patients, we can identify the cause. When we cannot, we consider idiopathic chronic fatigue or evaluate for Myalgic Encephalomyelitis / Chronic Fatigue Syndrome (ME/CFS) — a diagnosis of exclusion. ME/CFS is a complex, often debilitating condition. According to the National Academy of Medicine criteria, symptoms must last at least six months, be of moderate to severe intensity, and significantly reduce activity levels.
Core features include:
- profound, persistent fatigue
- post-exertional malaise (symptom worsening after physical or mental activity)
- non-restorative sleep
- cognitive difficulties
- orthostatic intolerance (symptoms worsening in upright posture)
Additional symptoms may include muscle and joint pains, sore throat, headaches, nausea, sensitivity to alcohol or medications, and new or worsening allergies.
There is no single test for ME/CFS — diagnosis relies on clinical criteria, careful history, and ruling out other conditions. A high-quality evaluation does not start with a long list of tests. It starts with conversation.
- Detailed history and physical examination
This step often provides more information than any lab test. We discuss:
- sleep patterns
- lifestyle and stress
- medication use
- infections
- other symptoms
- daily functional limitations
- Targeted laboratory testing
Not “everything at once,” but what is truly necessary:
- complete blood count
- basic biochemistry panel
- thyroid-stimulating hormone (TSH)
- screening for hepatitis C, HIV, and age-appropriate cancer screening is updated when needed
Extensive autoimmune panels, vitamin cascades, and “hormone profiles” without clinical indication are not recommended.
- Long-term follow-up
Fatigue often requires observation over time. We stay in contact with our patients, monitor symptoms, adjust plans, and support them through each stage of evaluation and treatment.
We treat the underlying condition directly — whether it is iron deficiency, thyroid disease, sleep apnea, medication side effect, or another medical issue.
If fatigue remains unexplained — we focus on supportive, evidence-based strategies:
- regular follow-up appointments
- cognitive-behavioral therapy (when appropriate)
- gradually titrated physical activity (only within a patient’s tolerated range)
- addressing sleep, pain, anxiety, or mood symptoms carefully and individually
- avoiding stimulants or unproven medications
For ME/CFS, treatment aims to reduce symptom load and improve quality of life. There is no cure, but many people experience stabilization or improvement over time.
We do not recommend:
- unnecessary extensive testing
- “treating everything at once”
- supplements or medications without proven benefit
- antibiotics or antivirals without indication
- overly aggressive exercise programs
- creating a “chronic patient” label without basis
A careful, minimalistic, patient-centered approach is often more effective — and safer. Fatigue can be frightening, especially when it interferes with work, studies, relationships, and daily life. Many people feel misunderstood — even by medical professionals. But here is what we want every patient to know: your symptoms are real. Your experience is valid. And there is always a path forward — even if оно не быстрый. The right evaluation, the right doctor, and the right plan can significantly change your quality of life.
Seek medical evaluation if you experience:
- persistent fatigue longer than 1–3 months
- noticeable drop in daily functioning
- poor recovery after activity
- non-restorative sleep
- dizziness when standing
- any new concerning symptoms
Early evaluation helps avoid unnecessary tests and long delays in understanding what’s happening. Fatigue is not a sentence. It is an invitation to look deeper — carefully, respectfully, and professionally. If you feel that your body is sending you this signal, we are here to help you understand it.