John M. Rhoads
To the internist or family physician, fatigue is probably the most commonly voiced complaint. It is often attributed to overwork, but seldom is this a correct diagnosis. In fact, it is almost axiomatic that if a patient complains of being overworked, he is not. Such a complaint was likely to be true in the early days of the Industrial Revolution, when work weeks ranged from 60 to 80 hours, and the seven-day week was the rule. At present, when the 40-hour week is standard, and where a 26-hour week is standard for one craft union in the nation's largest city, it may be surprising that anyone is overworked.
However, there are special groups of individuals who are susceptible to overwork. These people continue in the mode of the last century, when the working man labored from sunrise to sunset and beyond. No employer would be allowed to work his employees to such an excess. The exceptions are self employers who occupy open-ended positions. This group includes business executives, lawyers, doctors, accountants, clergymen, and occasionally even housewives.
Members of this group consult a physician, not with a complaint of overwork, but rather with the complaint that they are unable to work as long and as well as they feel they should. This is usually an incidental complaint, the chief complaint being one of a variety of physical symptoms. Symptoms may be quite variable, depending on the state or degree of exhaustion, the symbolic importance of particular symptoms, and chance. They commonly include fatigue, irritability, sleep disturbances, difficulty concentrating, memory lapses, confusional episodes, depression, gastrointestinal malfunctions, cardiovascular disturbances, or neuromuscular complaints.
Most persons in executive positions or professions or who are self-employed are able to pace themselves by balancing their drive,