In this YouTube monologue Dr. Ashley Frazee, a board‑certified physician who runs a direct‑primary‑care (DPC) clinic in Mesa, Arizona, outlines a practical roadmap for patients suffering from chronic fatigue. She begins by urging viewers to advocate for themselves at the primary‑care level, requesting a specific set of baseline labs (CBC, comprehensive metabolic panel, thyroid panel, iron studies, and, when indicated, an ANA autoimmune screen). She then explains how to assess sleep disturbances, recommending home sleep‑study kits as a convenient, out‑of‑pocket alternative to in‑center polysomnography. Dr. Frazee describes how to interpret results and spot red‑flag clinician behaviors—such as dismissiveness, rushed visits, or over‑reliance on BMI—as signals to seek another provider. She advocates moving to a DPC or other non‑insurance‑bound practice where longer appointments allow deeper exploration of lifestyle, stress, hormonal balance, cortisol, and insulin resistance. Caution is given about hormone or naturopathic clinics that may prioritize sales over care. For cases that remain unexplained, she suggests considering mitochondrial dysfunction and optional genetic SNP testing (e.g., MTHFR) with targeted supplementation. Throughout, the message is that fatigue is rarely “just fatigue,” and patients deserve a thorough workup and a clinician willing to investigate all possible contributors.
Chapters
Want more energy? Who doesn't? Listen, if you feel like something's missing, like there's a key to unlocking the energy that you know you should have, then keep watching because I'm a board-certified doctor in the US. And for the past several years, I've been working directly for my patients outside the bounds of insurance and government healthcare in order to get down to the problem of things that insurance doesn't normally pay for, like fatigue. And while I may not have every answer, I do know that every person deserves a full workup before throwing in the towel. And I also know that doctors find it hard pressed to give you that full workup within a 5-minute visit. So they brush it off. But when your body keeps hitting the brakes, there's a reason for that. And no, it's not always just you're getting older or you're too stressed out. So buckle up because I'm going to give you a roadmap to at least start looking for the answers that you deserve for why you're so fatigued. First things first, go ahead and go to your PCP. Any doctor will do. And say something like this: I feel like something's off. I'm abnormally tired all the time. Just mean it when you say it because they're going to need a reason to actually help you out. And most doctors are going to be willing to do this next step, which is get some blood work. You want a basic panel, it's fine. Just make sure that when they order labs, work on you, you ask for these specific things. And these aren't anything crazy, it's just a standard panel that I order on almost anybody every year. And that's a CBC, your blood counts, your metabolic panel, your blood sugar, your liver, your kidney function, your electrolytes. But do make sure they're going to order a thyroid panel and an iron panel. Most doctors will order thyroid panels, but you'd be surprised at how many patients I met who for years were getting standard panels through their regular PCP and never got an iron check or a thyroid check. And if you're feeling really spicy and you've got a family member, maybe a mom or a dad who has some sort of autoimmune disease, go ahead and ask for an autoimmune workup too, an ANA or something like that. ANA is a screening lab panel that you can use to rule out certain autoimmune diseases. Now, most doctors are going to ask you about your sleep. Now, any good doctor would, right? If you have any inkling that your sleep is off or you wake up in the middle of the night a lot, you wake up with a racing heartbeat or kind of gasping for air, or somebody who sleeps next to you just says that you saw logs all night, go ahead and ask for a sleep study. Now, I know what you're thinking. Sleep study is not something that I want to do. I don't want to go into a center and sleep Hooked up to a bunch of wires all night. Who wants to do that? But these days they have home sleep studies. You get a kit delivered to your door, you wrap a piece of cloth tape around your thumb and you sleep with it all night. You send the kit back and this can diagnose a lot of sleep problems. It's not perfect, but it's pretty good, especially if you're not willing to go to a sleep center. And just for reference, most of these cost about $300 out of pocket if your health insurance won't cover it. Okay. And once you get the results, don't settle for a call where somebody just tells you that everything's normal. Ask for the reasons, ask for the results. You'd be surprised at how many will just kind of accept what a doctor says, or they'll accept everything's normal and not ask for the results. So go ahead and get your results, ask for an explanation. If everything's normal and that's all they're willing to say, then okay, thank them and move on, right? There's some red flags in an exam room that you can kind of predict if a doctor's gonna be willing to go deeper into all this stuff with you or not. Like if they brush you off in the room, if they kind of seem like they're dismissing your issues, or if they seem super rushed or only give you 5 minutes. Which I know a lot of doctors only have 5 minutes to spend with you, but if they're not laser-focused on you in that 5 minutes and they don't try to give you some answers or they don't try to dig into your life, your lifestyle, your work, your sleep, et cetera, then this might not be the right doctor to go any further with. Or if they say, hey, well, your BMI is over 30 and you just need to lose weight, that's a red flag. Go ahead and move on. Find another doctor. You've got enough answers for now. Okay, so everything's normal. So now what do you do? Now's the time to find somebody who doesn't necessarily work within insurance or within government healthcare. You really You really need a doctor who has some time to sit down with you and dig into those things that I was mentioning. Let's talk about your life. Let's talk about your job, your family. How stressed out are you? And if you did all the testing that I mentioned before, now you want to talk about things like hormones, stress, cortisol levels, insulin resistance, things that really take time to think about and explain, things that are going to take more than a 5-minute visit. Because honestly, your story is going to take about 15 minutes just to explain to the doctor in most cases. And then the doctor's going to need to digest that and come up with an answer for you. Or a plan for you of how to tackle these things one by one. And just be really careful if you're going to something like a hormone clinic or a naturopath clinic, make sure that you're not just going to buy whatever they sell you from the get-go. It's really important that you get the sense that they're going to actually care about you versus sell you something. We can check into your hormones, we can check your cortisol levels, we can check your insulin resistance, we can try various things to try and correct some of those imbalances. But I'm also going to ask you some uncomfortable things and things that you've already been thinking about, such as, are you kind of constantly stressed out? Mm-hmm. Overstimulated? Is your work too stressful? Is your family too stressful? Do you have 4 kids? Are you scrolling on Instagram or TikTok all day and that's taking up a lot of your brain power? Do you have ADHD and it's undiagnosed and you can't stop thinking at night and you can't relax? So those things are all important, right? But we really just need the time to spend together to kind of dump all of that out onto the table and pick through what's important and what's off and, and what could be causing your fatigue. And if we've done all of that and we still have no answers, then it might be time to get a little bit weird. And this is just coming from somebody who's not worked in the bounds of insurance so long, so call me weird if you want to, but it might be worth looking into something like mitochondrial support. So what I mean by that is, are the powerhouses of your cells working properly? Over time, basically, your mitochondria can start to function poorly, and if they do, then adding some specific supplements into your regimen can actually help wake them up or make them more efficient. And if you want to get really technical with it, you can do some testing to figure out if your mitochondria aren't working super well. You can get genetic SNP tests. The most popular one of these is the MTHFR test. In which up to half the population has at least 1 out of 4 copies of this gene not working properly. And the fix for it is actually quite simple. It's just some supplementation. And there's several other genetic SNPs that can be off, and the testing for that is available to you. So all of that to be said, fatigue is not always just fatigue, and you're not crazy for wanting real answers. You just got to find somebody who's willing to dig in and figure it out for you, somebody who's willing to look at all the areas and aspects of your life that could be off Or if it is just stress in life getting to you. Hopefully you can use this stepwise plan to get some answers. I'm Dr. Ashley Frazee. I run a direct primary care clinic in Mesa, Arizona. Direct primary care is where you take insurance out of the equation and have doctors working directly for you. If you wanna learn more about direct primary care, there are links in my description, and you guys have a good day.
