Lesson 1Systematic symptom inquiry: sleep, mood, cognition, weight, feversYou will learn a systematic approach to symptom inquiry in patients with fatigue, covering sleep quality, mood, cognition, appetite, weight change, fevers, night sweats, and pain, to build a focused differential diagnosis and guide testing appropriate for New Zealand healthcare practices.
Clarifying nonrestorative sleep and snoringScreening for low mood, anhedonia, and anxietyAssessing concentration, memory, and brain fogAsking about weight change and appetite shiftsEvaluating fevers, chills, sweats, and myalgiasLesson 2How to ask about psychiatric symptoms: depression, anxiety, PTSDThis section covers how to ask about depression, anxiety, PTSD, and related symptoms in a sensitive, trauma-informed manner, using validated screening tools, normalising language, and clear follow-up questions about risk and impairment, tailored to cultural sensitivities in New Zealand.
Using PHQ-2 and PHQ-9 in fatigue evaluationScreening for generalised anxiety symptomsTrauma-informed questions about PTSD featuresAssessing suicidality and self-harm riskExploring sleep, guilt, and concentration changesLesson 3Framing questions to elicit sleep hygiene, shift work, and circadian issuesThis section focuses on asking precise questions about sleep schedule, sleep hygiene, shift work, and circadian disruption, helping you distinguish behavioural sleep issues from primary sleep disorders and medical causes of fatigue, considering common work patterns in New Zealand.
Characterising bedtime, wake time, and variabilityCaffeine, alcohol, and sedative use before sleepScreening for shift work and rotating schedulesIdentifying jet lag and circadian misalignmentBedroom environment and pre-sleep routinesLesson 4Medication, substance, and supplement review focused on fatigue causesThis section focuses on a detailed review of prescription drugs, over-the-counter agents, substances, and supplements that may cause or worsen fatigue, emphasising specific question wording and strategies to improve patient disclosure, relevant to New Zealand prescribing practices.
Identifying sedating and anticholinergic drugsScreening for beta-blockers and antihypertensivesAsking about alcohol, cannabis, and illicit drugsReviewing OTC antihistamines and sleep aidsDocumenting herbal and dietary supplement useLesson 5Functional impact and screening for red flags (work, ADLs, safety)Here you will learn to assess how fatigue affects work, school, driving, and self-care, and to screen for red flags such as cardiopulmonary compromise, infection, malignancy, and suicidality that require urgent evaluation or higher level of care within New Zealand's health system.
Assessing work and school performance changesEvaluating ADLs, IADLs, and caregiver rolesScreening for cardiopulmonary red flag symptomsIdentifying infection, malignancy, and weight lossAssessing safety risks including falls and drivingLesson 6Principles of focused history-taking in primary careThis section explains how to structure a focused fatigue history in primary care, balancing thoroughness with time limits, using open and closed questions, prioritising safety, and tailoring the interview to patient age, comorbidities, and visit context in a Kiwi clinic setting.
Setting agenda and clarifying patient concernsUsing open-ended questions to start historyTargeted review of systems for fatigueBalancing thoroughness with time constraintsAdapting history to acute vs chronic fatigueLesson 7Documentation templates and succinct handoff language for preceptorsHere you will learn to document a concise, problem-focused fatigue history using templates, key phrases, and structured assessment, and to deliver succinct, organised verbal handoffs that highlight red flags and next diagnostic steps, aligned with New Zealand documentation standards.
SOAP note structure for fatigue encountersEfficient phrasing of pertinent positivesDocumenting pertinent negatives and red flagsSummarising functional impact and safety issuesOrganising a clear, concise verbal handoffLesson 8Assessing menstrual, menopausal, and endocrine history in middle-aged patientsThis section teaches how to obtain menstrual, menopausal, thyroid, and other endocrine histories in middle-aged patients with fatigue, including cycle patterns, vasomotor symptoms, hormone therapy, and risk factors for endocrine disorders, considering New Zealand demographics.
Characterising menstrual regularity and flowScreening for perimenopausal vasomotor symptomsHistory of hormone therapy and contraceptivesTargeted thyroid and adrenal symptom questionsAssessing diabetes and metabolic syndrome risksLesson 9Targeted family and social history questions relevant to fatigueHere you will learn to obtain targeted family and social histories relevant to fatigue, including heritable conditions, caregiving burden, occupational exposures, financial stress, and lifestyle factors that influence sleep and energy, with a focus on New Zealand social contexts.
Family history of thyroid and autoimmune diseaseHereditary sleep, cardiac, and mood disordersAssessing caregiving roles and burnout riskOccupational demands and environmental exposuresFinancial, housing, and food insecurity screeningLesson 10Temporal features: onset, duration, pattern, triggersYou will learn to characterise the temporal profile of fatigue, including onset, duration, daily pattern, triggers, and relieving factors, to distinguish acute from chronic fatigue and identify clues to infectious, endocrine, or psychiatric causes in everyday practice.
Clarifying acute, subacute, or chronic onsetDaily pattern and variability of fatigueIdentifying exertional and cognitive triggersRelieving factors and rest responseTemporal links to illness, stress, or events
