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

Dolphin

Dolphin

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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)


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.
 

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.
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Dolphin said:
Fatigue is a common symptom in primary healthcare, affecting 10–30% of patients, and is associated with increased healthcare consumption and functional disability.
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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.
 
The paper said:
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.
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The main focus of the research group is to develop scalable psychological treatments for primary care patients suffering from persistent fatigue
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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.
 
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)
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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.
 
Will nobody think of the poor healthcare professionals? I feel like they need a psychological intervention. Very negative and self-perpetuating.

Wow if they feel frustrated, wait until they get ill with something there’s no treatment for.
 
This study is a preparation for another study, namely the Fatigue Study run by the Swedish branch of the Oslo Consortium. Four out of five researchers in this study are also working on the consortium study.

I have previously reported on major ethical problems regarding recruitment in the Fatigue Study. The article that is the subject of this thread confirms these problems, even though the same researchers conducted both studies. It is bizarre.

Read more on my blog (Google Translated):
Newly published article confirms ethical problems with the Fatigue Study

Threads S4ME on:

Fatigue study: Characterization, Treatment, and Long-term Follow-up of Fatigued Patients in Primary Care (iFAS), Lindsäter et al

Oslo Consortium: Oslo Chronic Fatigue Network
 
Ah, so the strategy seems to point out that things are awful, and present themselves as the solution, despite the fact that the current failure is entirely built out of the same fake solutions they want to sell yet again, has been the default for decades, and it works, things are just presently awful because they aren't quite biopsychosocial enough yet, or whatever, but it needs more research, or something generically vague like that.

Which is insane. Facts and reality don't matter at all, it's all Truthiness. I don't know if the attribution to Einstein is correct, but damn is this not fully committing to trying the same thing and expecting different results.

Also, something I thought of yesterday, about why no one involved seems capable of taking responsibility for anything, is that, like most people, they only judge themselves on their intentions, not the outcomes. Their intention is to help us, their way, as they see fit. The results are disastrous. But they can't find anything wrong with their intentions, they simply assume that the outcomes must align with them, and that when we criticize the outcomes, they feel that their intentions are attacked.

This isn't even amateur hour. Amateurs can do better than this when they actually work with reality as it is, and judge outcomes as they are. This is disaster hour.
 
It reminds me of King Charles II. He died of illnesses that the physicians had no way of treating at the time, but the physician’s prescribed treatments based on wrongful beliefs about his illness, hastened his death and caused him significant suffering before it.

The death of King Charles II — Centre for Evidence-Based Medicine (CEBM), University of Oxford

Charles II was born on 29 May 1630 to Charles I and his French wife, Henrietta Maria, and died on 6 February 1685. Here Jeff Aronson describes Charles’s final illness and suggests that his death was hastened by his doctors.
www.cebm.ox.ac.uk www.cebm.ox.ac.uk

Somehow, certain parts of healthcare have not moved on in the last 340 years.
 
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