Initial evaluation of the patient

• Review previous medications, patient records, medical reports, and laboratory test results. Often the patient has taken great effort to assemble records from visits to other providers, and these records will often contain very useful information. Also, duplicate testing may often be avoided if results of earlier tests can be utilized.
• Take a detailed history, including past history of other fatigue-like illnesses, significant psychiatric illness if any, a detailed review of systems, and determine what pattern of illness the patient has been experiencing.
• Perform a thorough physical examination. A physical examination may reveal issues that explain some of the symptoms.
• Lab studies should include a CBC with SED rate, chemical profile, thyroid function test, ANA, UA, EKG, chest x-ray, intermediate strength PPD, and if the patient has a fever over 101 degrees, include blood cultures.
• Other studies may also be indicated, such as CT or MRI brain scans or psychological testing.