This chapter, written for undergraduate medical students and post-graduate doctors in training, presents information on how to manage tiredness — a case which they are likely to encounter in the future in a general practice setting. It presents the case of a 63-year-old school dinner lady who has been treated in the past for arthritic joint pains and still takes occasional naproxen and paracetamol. She has a dull complexion, mousy hair, lacklustre clothes, a downcast expression and a subdued voice. The chapter provides details of the patients' medical history and the key findings of clinical examination, together with initial investigation results data for evaluation, and helps them develop their skills of clinical reasoning. Key questions then prompt the student to evaluate the patient, and reach a decision regarding their condition and the possible treatment plan.