Physicians’ experiences of assessing and supporting fatigued patients in primary care: a focus group study, 2025, Samuelsson

[Dolphin]

Physicians’ experiences of assessing and supporting fatigued patients in primary care: a focus group study - BMC Primary Care

Background Fatigue is a common symptom in primary healthcare, affecting 10–30% of patients, and is associated with increased healthcare consumption and functional disability. There is a lack of standardised guidelines to assess and treat patients with fatigue, and little is known about how...

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Physicians’ experiences of assessing and supporting fatigued patients in primary care: a focus group study​

• Research
• Open access
• Published: 09 June 2025
• Volume 26, article number 197, (2025)

• Conrad Samuelsson,
• Lisa Gunnarsson,
• Frank Svärdman,
• Christian Rück &
• Elin Lindsäter

Abstract​

Background​

Fatigue is a common symptom in primary healthcare, affecting 10–30% of patients, and is associated with increased healthcare consumption and functional disability. There is a lack of standardised guidelines to assess and treat patients with fatigue, and little is known about how patients are currently managed in primary healthcare. This study aimed to explore physicians' experiences of managing patients with fatigue in Swedish primary care to inform development of evidence-based care procedures.

Method​

Six semi-structured focus group interviews were conducted, including a total of 39 primary care physicians from three primary care centres in Stockholm. Data was analysed using thematic analysis.

Results​

The analysis generated the overarching theme "Frustration in the role as physician," consisting of two main themes: (1) “Time pressure and an empty toolbox”, highlighting the perceived lack of standardised assessment procedures, effective interventions, and sufficient time for care; and (2) “Challenges in the patient-physician relationship”, highlighting role ambivalence, ambivalence regarding sick leave, and the importance of reaching mutual understanding with the patient.

Conclusion​

Physicians often feel frustrated, ill-equipped, and time-pressured when managing patients with fatigue. There is a pressing need to develop evidence-based assessment procedures and treatments in the primary care context.

 

[Dolphin]

Researcher background and study conception​

The main focus of the research group is to develop scalable psychological treatments for primary care patients suffering from persistent fatigue, including exhaustion disorder. CS and EL developed the research questions and the interview protocol based on observations that physicians often express insecurity regarding assessment and management of fatigue. The questions in the interview protocol aimed to probe physician experiences and perceived challenges when it comes to assessing and managing patients with persistent fatigue by asking open-ended questions. Of interest was also how physicians communicate about fatigue with patients, including what diagnostic labels they use and how they discuss inconclusive test results. The semi-structured interview protocol is available in the online supplement.

 

[Peter T]

Fatigue is a common symptom in primary healthcare, affecting 10–30% of patients, and is associated with increased healthcare consumption and functional disability.

Are we seeing yet another example of failure to understand association is not causality?

Even if you could say that those with relatively high healthcare consumption experience ‘fatigue’, that tells us nothing about levels of fatigue in people who have learn that healthcare has nothing useful to offer them and have withdrawn from any healthcare consumption.

Given the lack of specificity in the term ‘fatigue’ all this tells us that people who are ‘unwell’ are ‘unwell’ and likely to seek medical support until such point that they learn not to.

 

[rvallee]

Physicians often feel frustrated, ill-equipped, and time-pressured when managing patients with fatigue. There is a pressing need to develop evidence-based assessment procedures and treatments in the primary care context.

The main focus of the research group is to develop scalable psychological treatments for primary care patients suffering from persistent fatigue

This would be funny, in a pathetic way, if it wasn't so harmful. Sometimes the reason for something is entirely explained by the motivations that are brought to it. Doing this has exactly zero chance of working, and we know this because it's literally the current state of failure. Good grief, even the lowest interns at a small company are usually expected to do better than this.

 

[rvallee]

Most of the comments support the fact that there is nothing that works, including, maybe especially so, the psychobehavioral clinics:

“I also think that the specialist clinics do almost nothing. […] They try B12 injections and nothing has an effect […] It’s been a great relief […] to send them to these clinics. […] they have disappeared from us for a while […]. But the way I see it they still come back, most of them, and have about the same plan” (PCC1, interview 1, participant 4)

Indeed they do nothing. Some comments talk about frustration at nothing working, but that is precisely how things work when you have nothing effective. Trying things that don't work is not the same thing as trying things that might work. You could sing all the songs ever written, forward and backward, and it wouldn't count as trying, because doing this is entirely irrelevant to the problem. The junk psychobehavioral pseudoscience is no different than this, it has zero chance of working.

It's definitely true that they have nothing. As a choice. Because this is simply not seen as a problem worth solving, and useless nonsense has been obsessively asserted to work even though it obviously doesn't. This will not get solved until it's taken seriously, and with competent tools and methods. This explicitly excludes all of clinical psychology, which is the universal hammer everyone ineffectually tries to deal with it.

This actually warrants turning back one false criticism that is laid on us: quit hoping that a magical solution will be handed to you, it won't happen, you have to work for it, and if you keep refusing to work on the problem as it is, then you are not going to achieve anything.

In a nutshell: quit whining or doing useless things and get to work. Because this is all still happening after decades of pushing the same junk pseudoscience onto the problem. Quit doing what doesn't work, damnit.