A Perth woman in her 30s posted a question that will sound painfully familiar to anyone who has spent years trying to explain exhaustion that does not behave like ordinary tiredness.

After four years of chronic fatigue, multiple GPs, nutritionists, psychiatrists, physios, endocrinologists, blood tests, a sleep study, scopes and an iron infusion, she asked r/perth for something very specific: doctors or specialists in Perth who would take her seriously and do a deeper search for the cause.

The thread quickly became less of a complaint and more of a crowdsourced referral notebook. None of it replaces medical advice, and Everything Perth has not independently vetted the individual practitioners named by commenters. But the answers are useful because they show the paths Perth patients are already piecing together when standard tests come back “normal” and life still does not.

First: is it ME/CFS, or chronic fatigue as a symptom?

One of the clearest comments cut through the terminology problem:

“Big question is whether you have post exertional malaise and thus ME/CFS, or the symptom chronic fatigue from something else.”

That distinction matters. Healthdirect describes ME/CFS as a complex illness where extreme tiredness and other symptoms reduce a person’s ability to function, with symptoms worsening after physical or mental effort and not improving properly with rest. The key phrase is post-exertional malaise, or PEM — a crash after activity that can be delayed and disproportionate.

That does not mean every exhausted person has ME/CFS. Chronic fatigue can sit inside many other problems: sleep disorders, autoimmune disease, thyroid disease, iron deficiency, long COVID, pain conditions, POTS, ADHD burnout, depression, medication effects, hormonal issues, coeliac disease, and more. But the thread’s best advice was to stop treating “fatigue” as a single bucket and start mapping patterns.

The Murdoch GP recommendation

The most concrete recommendation was Garden Family Medical Clinic in Murdoch, near Fiona Stanley Hospital, with one commenter specifically naming Dr Keren Witcombe:

“Ive been seeing the doctors there for around 3 years now after multiple attempts at getting help for my fatigue and other issues. Ive since been diagnosed with celiac disease, POTS, audhd and have been successfully medicated for the chronic fatigue. They listen so well and I’ve never once felt dismissed or silly.”

The value in that answer is not just the clinic name. It is the list of things eventually found: coeliac disease, POTS, ADHD/autism and chronic fatigue management. For someone with years of normal blood tests, a GP who is prepared to look across systems can be more useful than another quick ten-minute appointment.

ME/CFS-aware directories and support groups

Another commenter pointed to Emerge Australia’s services directory, which lists ME/CFS and long COVID-aware clinicians and services. Emerge itself cautions that it does not guarantee the quality of care from listed providers, but the directory can at least give patients a starting point when they are trying to find a clinician who recognises PEM and pacing.

“EMERGE Australia has a directory of doctors for ME/CFS (which chronic fatigue can be a symptom of).”

A support group was also suggested. That may sound soft compared with a specialist referral, but for conditions that are hard to diagnose and harder to manage, patient groups often know which clinics understand the illness, which questions to ask, and what language helps a GP write a useful referral.

The ADHD and autistic burnout thread

A large branch of the discussion focused on neurodivergence. One commenter asked whether masking ADHD symptoms might be part of the picture, especially for women who often reach adulthood before being properly diagnosed.

“Women have a much harder time it seems getting answer/diagnosis and the energy used just living is so substantial it just makes you so damn tired.”

Another commenter put it bluntly:

“Autistic burnout definitely fits a mid 30s chronic fatigue appearance.”

The original poster replied that she had been diagnosed with inattentive ADHD years earlier, had tried medication, and still felt unsure whether ADHD was the cause or whether fatigue was mimicking ADHD symptoms. That uncertainty is exactly why a proper clinician matters. The Reddit thread is not a diagnosis. But it did identify a real pathway: if ADHD or autistic burnout is already on the table, it may be worth revisiting with a psychiatrist or GP who understands adult neurodivergence rather than treating it as a side issue.

POTS, hypermobility and the body that keeps saying no

Several comments moved away from “energy” as an abstract idea and toward the body systems that can make standing, moving, sleeping and recovering harder.

One commenter described years of fatigue and pain before a POTS diagnosis, saying it was a relief to finally see abnormal blood pressure and heart-rate results after years of being told they were fine. Another connected hypermobility, allergies, hormones and fatigue, then named two Perth physiotherapy options from personal experience:

“I see a physiotherapist called Tracy Wallwork who really likes working with hypermobile people. She has been so helpful to me… Jeremy Wisdom at Wisdom Physio is also good for hypermobility.”

Hypermobility does not explain every case of fatigue, and physiotherapy is not a universal cure. But the comment is a good example of the thread’s real strength: people were not just saying “try harder” or “exercise more”. They were naming narrower assessments that can uncover why ordinary activity might be so draining.

Sleep testing: not just “are you overweight?”

The sleep comments were particularly practical. One person asked whether the poster had done both an overnight study and a daytime supervised test. The poster replied that she had only done a home study and had struggled to be taken seriously because she was female, not overweight and did not fit the usual sleep apnoea stereotype.

“You can have both UARS and apnea… and you can be underweight and have apnea.”

That commenter suggested asking an ENT office for sleep specialist recommendations and raised the possibility of Upper Airway Resistance Syndrome, dental splints, blocked nasal breathing and whether a supervised daytime sleep study might help if daytime sleepiness or naps are part of the pattern.

Rheumatology, pain and integrative clinics

Rheumatology came up when one commenter simply asked: “No rheumatologist?” When the poster said no, the commenter suggested asking a GP for a referral and named Hollywood Rheumatology, while warning that wait times for initial appointments can be long.

Other suggestions included a pain specialist, Village Medical Practice, Ellen Health or a GP advertising integrative medicine, and Biio in Subiaco. Biio drew mixed responses: one commenter said they had heard good things; another urged caution for complex cases, saying some patients had spent a lot of money being reassessed without meaningful treatment. A later commenter still called Biio “a bunch of legends” for women’s health.

That split is worth preserving. In complex fatigue, a clinic that is excellent for one person may be expensive and unhelpful for another. The most useful takeaway is not “go here”. It is “go in prepared”: bring a clear symptom timeline, what has already been tested, what worsens symptoms, what helps, medication history, sleep data, menstrual/hormonal patterns, infection history, pain and joint symptoms, and what you need the next doctor to rule in or rule out.

One commenter’s practical tracking idea

One of the best pieces of advice was not a clinic name at all. It was data.

“The one thing that has helped them be a bit more serrious is using step count and the impact that going over my limit has on my capacity to work/live/move after.”

For people with PEM-like crashes, a simple record of steps, activity, sleep and next-day symptoms can make a consultation more concrete. It turns “I’m tired all the time” into “when I go over this threshold, I lose two days”. That is harder to dismiss.

A Perth starting list from the thread

• Ask a trusted GP for a longer appointment and bring a one-page history: onset, major symptoms, prior tests, medications tried, what triggers crashes, and what function you have lost.
• If symptoms worsen after physical or mental effort, ask specifically about ME/CFS and post-exertional malaise.
• Check the Emerge Australia directory for ME/CFS and long COVID-aware clinicians, while remembering it is a directory, not an endorsement.
• Consider whether a proper sleep specialist review is still warranted, especially if the only test was a home study or if airway issues have been identified.
• If pain, joint issues, rashes, dizziness, faintness, hypermobility, dry eyes, autoimmune history or unusual inflammatory symptoms are present, ask whether rheumatology, allergy/immunology, POTS assessment or hypermobility-aware physio is appropriate.
• If ADHD or autism has been diagnosed or suspected, consider whether unmanaged ADHD, medication issues or autistic burnout might be part of the fatigue picture.
• Track step count, activity and delayed crashes for several weeks so the next doctor can see patterns.

The most moving part of the thread was not the clinic list. It was the recognition. One commenter wrote:

“The mental exhaustion of dealing with something chronic is real. You aren’t alone, keep pushing for answers.”

That is the heart of the story. Perth’s health system can be hard to navigate, especially when tests are normal and symptoms are disabling. But the thread showed something useful: people who have been through the maze remember the doors that eventually opened, and they are willing to point the next person toward them.

This article is general information and does not provide medical advice. Anyone experiencing severe, persistent or worsening fatigue should seek care from a qualified health professional. If symptoms are sudden, severe, associated with chest pain, fainting, neurological symptoms, shortness of breath or thoughts of self-harm, seek urgent medical help.

Sources: r/perth thread: “Looking for help with chronic fatigue in Perth”; Healthdirect: Chronic fatigue syndrome / ME; Emerge Australia Services Directory; CDC clinical care guidance on PEM and activity management.