Tiredness

We are writing to you regarding the article titled “Tiredness”
published in the BMJ 2007:334:1221, which was printed in the 10 minute
consultation section.
We found the article to be informative concerning a common problem with
the various issues, signs, symptoms and an excellent advised plan of
action. Many physical causes were mentioned including hypothyroidism,
autoimmune disease and malignancy.
However, we do believe there was an important omission. This was patient’s
medication which plays a significant part in today’s health care system
where poly-pharmacy is a growing issue albeit more so in the elderly.
Many patients seen in the primary care setting can possibly be on three or
more medication for various reasons and tiredness can be a known side
effect.Pervasive sense of tiredness can potentially undermine the Doctor
-Patient relationship as the medication advised is associated with an
undesireable experience.

The British National Formulary (BNF) lists tiredness, fatigue and
lethargy caused by many regularly used drug groups. A few of these
consist of antihypertensive, lipid regulating medication, corticosteroid,
antihistamine, antipsychotic, antidepressant, antiemmetic, opioid
analgesic and a few antidiabetic medication.
We are writing in part to congratulate you on an impressive article, but
also to point out this oversight as reviewing a patient’s medication would
be an integral part of a consultation with a patient presenting with
tiredness.

Competing interests:
None declared