Is it considered malpractice if a doctor diagnoses a patient with exhaustion without a thorough evaluation?

Dismissing Patient Complaints of Fatigue as "Just Exhaustion" May Constitute Medical Malpractice

Dismissing a patient's report of fatigue without proper evaluation constitutes medical malpractice as it fails to meet the standard of care and could lead to missed diagnoses of serious underlying conditions.

Understanding Fatigue as a Medical Symptom

Fatigue is a significant clinical symptom that requires proper medical evaluation, not dismissal as "just exhaustion." The National Comprehensive Cancer Network guidelines emphasize that fatigue should be systematically screened and assessed using validated instruments 1. Fatigue exists on a spectrum:

• Mild fatigue (1-3 on a 0-10 scale): Requires education and monitoring
• Moderate fatigue (4-6 on a 0-10 scale): Requires evaluation
• Severe fatigue (7-10 on a 0-10 scale): Requires prompt and thorough evaluation 2, 1

Why Dismissal of Fatigue Constitutes Malpractice

1. Failure to Meet Standard of Care

The standard of care requires physicians to:

• Perform a focused history and physical examination when fatigue is reported as moderate to severe 2
• Conduct appropriate laboratory testing including complete blood count, comprehensive metabolic panel, and thyroid-stimulating hormone 1
• Evaluate for common causes of fatigue including pain, emotional distress, sleep disturbance, anemia, nutritional deficiencies, and comorbidities 1

2. Risk of Missing Serious Conditions

Fatigue can be a symptom of numerous serious conditions:

• Cardiac dysfunction (exhaustion is a prevalent precursor of sudden cardiac death) 3
• Respiratory disorders (including those with life-threatening features) 2
• Cancer and cancer-related complications 2, 1
• Endocrine disorders 1

3. Legal Precedent for Malpractice

Medical malpractice litigation commonly involves:

• Failure to diagnose (the most common allegation in malpractice suits) 2
• Failure to perform adequate examination related to the chief complaint 4
• Deviation from the standard of care causing injury to the patient 5

A systematic review of malpractice litigation found that failure to diagnose and failure to treat are the most common allegations in medical malpractice lawsuits, with significant financial consequences (average payout in plaintiff verdicts was $9,705,099) 2.

Proper Approach to Evaluating Fatigue

When a patient reports fatigue, physicians should:

1. Quantify severity using a validated scale (0-10) 2, 1
2. Conduct a focused evaluation including:
   • Onset, pattern, duration, and impact on daily functioning
   • Factors that worsen or alleviate symptoms 1
3. Perform appropriate laboratory testing:
   • Complete blood count
   • Comprehensive metabolic panel
   • Thyroid-stimulating hormone
   • Additional tests based on clinical suspicion 1
4. Assess for common contributing factors:
   • Pain
   • Emotional distress
   • Sleep disturbance
   • Anemia
   • Nutritional status
   • Activity level
   • Medication side effects
   • Comorbidities 1

Patient Satisfaction and Expectations

Research shows that patients report more illness worry (20% vs. 17%), unmet expectations (17% vs. 13%), and dissatisfaction with their physician when no diagnosis is made after reporting symptoms 6. This dissatisfaction is primarily related to the medical examination and physician explanations 6.

Conclusion

Dismissing fatigue as "just exhaustion" without proper evaluation represents a deviation from the standard of care and constitutes medical malpractice. Physicians must take fatigue seriously, conduct appropriate evaluations, and consider the broad differential diagnosis to avoid missing potentially serious conditions that could lead to increased morbidity and mortality.