"Hello, I’m [Your Name], one of the doctors/nurses. I understand you've come in today because you've been feeling tired. Is that right?"
"Before we go any further, what are your thoughts about what might be causing your tiredness, or what it might mean?"
"And is there anything in particular that you're worried about, or anything you were hoping we could achieve during our conversation today?"
"Could you please describe your tiredness for me? Is it more a feeling of sleepiness during the day, a lack of energy or being easily exhausted (fatigue), or physical weakness? Or is it a combination?"
"When did this tiredness first start? Did it come on very suddenly, or has it been a gradual change? How long has it been present?"
"Have you noticed any other symptoms happening with the tiredness? For example, have you had any fevers, or changes in your weight? What about changes in your mood, or any new pains? Are you experiencing shortness of breath, palpitations, any stomach or bowel issues, or changes to your skin or hair?"
"How has the tiredness changed over time? Is it constant and getting worse? Does it come and go, or is it worse after certain activities?"
"I also need to ask about your mood. Have you been feeling down, depressed, or losing interest in things you used to enjoy? Have you had any changes in your appetite or sleep, or felt guilty or worthless?"
"Could you describe your typical bedtime routine? What time do you usually go to bed, and how long does it take you to fall asleep? Do you wake up often during the night, and what time do you typically wake up in the morning? Do you snore loudly, or has anyone witnessed you stop breathing in your sleep? Do your legs feel restless at night?"
"If you're experiencing sleepiness during the day, do you ever fall asleep unintentionally, even when you're trying to stay awake? For example, while working, talking, watching TV, or even driving? (If Epworth Scale is used: 'I'm going to ask you a few questions about how likely you are to fall asleep in certain situations.')"
"I also need to ask about some important 'red flag' symptoms. Have you had any unexplained significant weight loss? Any new weakness, numbness, or changes in your vision that could suggest a neurological problem? Have you had any persistent fevers or night sweats? Have you recently had any tick bites, or do you have any new joint pain or swelling? What about new lumps or bumps, or unusual bleeding or bruising? Any severe headaches?"
"Based on what you've told me, I might ask some specific questions about certain conditions. For example, do you feel cold all the time, gained weight, or have dry skin or hair loss? (Hypothyroidism) Or, along with the snoring, do you wake up with headaches? (Sleep apnoea) Have you noticed increasing shortness of breath, especially on exertion, or swelling in your ankles? (Heart failure) Are you looking pale, short of breath, or have cold hands and feet? (Anaemia) Or are you excessively thirsty, passing urine a lot, or have blurred vision? (Diabetes)"
"Are you experiencing any other symptoms anywhere else in your body? This helps us to get a full picture and look for any other clues."
"Do you have any existing medical conditions, such as anaemia, thyroid disorders, diabetes, heart conditions, kidney or liver disease, autoimmune conditions, or any chronic infections? What about any diagnosed sleep disorders, or mental health conditions like depression?"
"Have you ever had any operations or procedures?"
"For women, I'd also like to ask a few questions about your gynaecological history. Are your menstrual periods regular, or are they heavy? Have you been pregnant before, and what was your experience with that? Are you currently going through menopause, or have you already?"
"Are you currently taking any medications, including anything prescribed by a doctor, or any over-the-counter medicines, supplements, or herbal remedies? Some medications, like sleeping tablets, certain antihistamines, beta-blockers, antidepressants, or strong painkillers, can cause tiredness."
"Have there been any recent changes to your medications?"
"Do you have any allergies to medications or anything else? If so, what kind of reaction did you have?"
"Does anyone in your close family have a history of diseases that might be associated with tiredness, such as sleep disorders, heart conditions, autoimmune diseases, neurological conditions, endocrine disorders (like thyroid problems), kidney or liver impairment, or any cancers? If so, can you tell me at what age they developed these conditions?"
"Could you tell me a little about your living situation and who you live with? Do you have good social support around you? Are you able to manage all your daily activities independently, or has the tiredness affected this?"
"How about your lifestyle? Do you smoke, and if so, how much? How much alcohol do you drink in a week? Do you use any recreational drugs?"
"What's your typical diet like, and how about your fluid intake and exercise levels? How do you manage stress?"
"What kind of work do you do? If your tiredness is significant, it's important to identify any high-risk activities in your job where fatigue could impair your performance."
"Regarding driving, if your tiredness is causing you to fall asleep unintentionally or significantly affecting your concentration, it's important to be careful. You may need to inform the DVLA (or your local licensing authority) if your condition affects your ability to drive safely."