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When It Comes To Common Symptoms, The Doctor May Not Know What’s Wrong With You, And That’s OK

Doctor and patient

If you've ever made a doctor’s appointment because of severe neck pain, exhaustion, or sinus pressure, only to be told that your symptoms are “normal” or there’s “nothing wrong with you,” you know how frustrating it can be. When you feel poorly, you want to know why. But physicians are trained to offer a diagnosis and when symptoms don’t add up to one, they don’t always know what to say.

That happens pretty often. Areview of medical literature published last year in the Annals of Internal Medicine found that doctors in outpatient settings fail to connect a patient’s symptoms to a physical cause one-third to one-half of the time. Study author Kurt Kroenke, M.D., a professor of medicine at Indiana University Medical School, says in these cases better communication between patients and doctors can improve quality of care.  

About half of the most common symptoms are pain-related, such as headache, back pain, neck pain, or arthritis. The rest are upper respiratory complaints and other problems such as dizziness, fatigue, stomach problems, and chest pains. And while most of these symptoms go away on their own, that doesn’t mean doctors shouldn’t take their patients’ concerns seriously, says Kroenke.

Here are five insights  Kroenke shared in an interview with Sound Medicine that could improve your next conversation with your doctor.

1. Doctors make most diagnoses based on talking to you about your symptoms, rather than tests.

According to his study, about 75 percent of information useful in making a diagnosis comes from the patient’s history – the story you tell your doctor about what’s been going on. Another 10 to 15 percent comes from the physical examination. Tests provide the least useful source of information.

2.  Most of the time, “a follow-up is better than a work-up.”

If the history and the physical exam don't yield the cause for the symptoms, often “a follow up is better than a work-up," Kroenke says. Rather than spend time and money on tests that often prove unnecessary, he’ll usually tell a patient “If it doesn’t get better, let me know.”  Of course there are exceptions: for instance if a patient has chest pain, or has suffered a stroke.

3. Doctors can still help you feel better even without a diagnosis.

According to Kroenke, in most cases a doctor can safely treat your symptoms even if he or she has not identified a cause. He says a doctor should let a patient know that she understands the symptoms are real, and should avoid using phrases like “ you’re perfectly normal” or “I can’t find anything wrong with you” when a patient is feeling poorly. As a patient, you should feel you’re being taken seriously.  

4. Most common symptoms disappear on their own.

As a general rule, about 75 percent of patients who present in primary care will see their symptoms disappear in a few weeks or months. So if you don’t feel better in a week or two, your symptoms worsen, or you develop new ones, it makes sense to schedule a follow-up visit, Kroenke says.  

5. Share your symptoms, even the ones the doctor doesn’t ask about.

Bring in a list of your top two or three symptoms, Kroenke recommends. If you have a concern that the doctor doesn’t ask about, bring it up.