The Corpus Callosum


I haven’t been a good blog-citizen lately.  And no, it is not
because of fatigue.  Anyway, I’ve going to try to get back to
looking at other people’s blogs more, and not just here at

Dr. Serani kindly pointed
an article
on common causes of fatigue.  Sleep disorders, thyroid problems,
diabetes, depression, and anemia. 

My comment of this has to do with how these problems are screened for
in general medical practice. 

Granted, I have a biased view of this, both because of my specialty,
and because I am exposed to a decidedly nonrandom sample of medical
practice.  Anyway, with those limitations in mind, my opinion is
this: most doctors do not miss thyroid problems, diabetes, or
anemia.  Most will at least think of depression. 

In fact, a few years ago, I went to my own primary care doc’s
office.  When I called for an appointment, I was asked the reason
for the visit.  I said I had a problem with insomnia.  When I
arrived, the receptionist dutifully gave me a questionnaire that was a
screen for depression.  In fact, I had a broken arm, which was
making it hard to sleep.  I had not mentioned that, because my
doctor already knew I had a broken arm, and that was not really the
reason I went in at that time.  Anyway, I dutifully filled it
out.  When the doc came in, he saw it, and laughed, and
apologized, “she was just following orders.” 

Actually, I appreciated it.  I was glad to see that such a common
problem was not being overlooked.  (I got some trazodone, which
helped some, not a lot, but enough.  I didn’t want to take the
Vicodin I already had, because it made me dumb.)

But I am concerned that it seems that a lot of times, people are not
checked for sleep disorders (usually sleep apnea, restless leg
syndrome, or more rarely, narcolepsy).  I’m not sure why, because
it seems kind of obvious.  It seems that if someone complains of
fatigue, it would make sense to survey for signs and symptoms that
would be be suggestive of a sleep disorder. 

Perhaps this is because it takes time.  A careful interview is
slow.  You have to listen.  Many questions may be met with
vague, equivocal responses.  This can be frustrating.  Plus,
the most valuable information often comes from whomever sleeps next to
the patient, who may not even be present at the appointment.  In
contrast, it is easy to check for diabetes, anemia, and thyroid
disease.  Yes, sometimes the blood tests are equivocal, not to
mention wrong.  But the interpretation of the tests usually is
reasonably straightforward. 


  1. #1 HP
    August 13, 2009

    Sample size: 1

    A few years back, I was having horrible trouble sleeping, and had made several trips to my doctor in which I described, to the best of my abilities, the problems I was having. (Good patients don’t self-diagnose, I’ve been told.) He mostly treated me with antibiotics for respiratory infections I didn’t have. Finally, convinced I had sleep apnea but needing a referral for insurance purposes, I went to WebMD and looked at the physician’s site where it said, “If a patient presents with [symptoms], refer them to a sleep specialist for apnea.”

    On my next visit, I dutifully recited the list of symptoms to my doctor (they were not, necessarily, my symptoms), got a referral, got fitted with a CPAP, and had my first dreams in 3 years.

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