Intended for healthcare professionals

Practice 10-minute consultation


BMJ 2007; 334 doi: (Published 07 June 2007) Cite this as: BMJ 2007;334:1221
  1. George Moncrieff, general practitioner,
  2. John Fletcher, general practitioner
  1. Bicester Health Centre, Bicester OX26 6AT
  1. Correspondence to: G Moncrieff georgemoncrieff{at}

    During a routine appointment a 48 year old woman tells you that she feels tired all the time. You know that she has changed jobs recently and that her daughter has recently returned to university.

    What issues you should cover

    Reasons for consulting

    Tiredness is a common presenting symptom. Often the cause may be physical; diseases such as hypothyroidism, autoimmune disease, liver or kidney disease, or even cancer may result in tiredness. Tiredness is, however, more often due to depression or the stresses of life circumstances.

    Tiredness may not be the main focus of her concerns, and she may only offer it as an initial symptom to see whether you are sympathetic and interested. Her main issue may be a more sensitive one, such as the menopause or the stress of recent events in her life. Patients may consider tiredness to be a more legitimate symptom to bring to a doctor than, say, unhappiness. Although …

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