By Nina Radcliff, MD
“Always listen to the patient; they might be telling you the diagnosis.”- Sir William Osler.
Several of my professors in medical school told me that 90 percent of all medical diagnoses can be made by carefully listening to the patient. After all, who can recognize the “in’s” of their own body better?
We are increasingly seeing the benefits of coordinated care — where the patient and their doctor work together to achieve best health. As patients that means we must listen to our bodies when something is awry, immediately recognize warning signs, and be able to describe a proper history, including a family history, so our doctors have as much information as possible when asked to diagnose a medical problem.
This is particularly the case when it comes to difficult-to-diagnose illnesses.
One of the most frustrating issues with diagnosing cancer is that the tumor often has to become large enough to cause a problem or symptom.
This conundrum leads to delays in diagnosis and can limit treatment options.
To help with early detection, these are some “vague” symptoms that we should be on the lookout for: fatigue; unexplained weight loss; fever; pain; change in appetite; nausea or vomiting; persistent cough or hoarseness; an unexplained lump; persistent changes in bowel or bladder habits (or blood in the stool or urine); difficulty
swallowing; and a change in the appearance of a mole.
This top killer of Americans — men and women — does not always present as telltale sudden, crushing chest pain. “Atypical” symptoms that may be completely unrelated to chest pain include: Pain and discomfort in the neck, shoulder, upper back, or abdomen; shortness of breath; nausea or vomiting; sweating; lightheadedness or dizziness; and unusual fatigue. Knowing our risk factors for heart disease and being aware of these atypical signs can be lifesaving.
Common symptoms include feelings of sadness, anxiety, and irritability. However, depression can present with vague symptoms such as chronic fatigue, concentration issues, and sleep problems making the disease more difficult to pin down. Additionally, we are gaining more awareness that there may be “gender specific” symptoms and that men may present with emotions that seem opposite: Anger, irritability, reckless behavior, and aggression. This can lead to delays in seeking diagnosis and treatment, despite it affecting both genders almost equally.
An autoimmune disease where our body abnormally attacks itself and causes inflammation. The hallmark sign is a butterfly-shaped rash across a person’s cheeks. However, lupus has also been called “the disease of a thousand faces” because it may instead present as joint pain, fatigue, kidney disease, heart problems, headaches/migraines, seizures, or schizophrenia (paranoia, hearing voices). To make the waters even murkier, there is no one test to diagnose lupus.
It is estimated that those with Lyme disease go 1.2 years before they receive an accurate diagnosis. The primary, telltale symptom is a bull’s eye rash that develops at the site of the tick bite. However, in up to 30 percent of people, no rash occurs and they only have vague symptoms such as muscle and joint pain, fever, headache, stiffness, and fatigue.
An immune reaction to gluten—a protein in wheat, rye, and barley — that can cause vomiting, diarrhea, abdominal pain, bloating, weight loss, leg cramps, itchy skin, joint pain, heartburn, or headaches.
Because the symptoms are vague, it takes an average of 6-10 years for patients to be properly diagnosed! The diagnosis can be made via a blood test; however, up to 10 percent of people with celiac disease may test negative. Additionally, an endoscopic procedure can be performed to assess the level of damage.
It is estimated that up to 165,000 stroke cases every year are misdiagnosed! Because our brain is involved in virtually every aspect of our existence, any sudden onset of confusion, difficulty with speaking, seeing, or moving, dizziness or loss of balance should be an alarm—regardless of age — that this may be a stroke and mandates immediate medical attention.
As patients, listening to subtle, vague, or stealth clues that our body is sending is a critical part of your doctor’s diagnosis. Before scheduled visits, take some time to write down your symptoms and other
pertinent information so that you can provide your doctor with a focused history. And during the visit, do not be shy. Ask them what their differential diagnosis is — the medical term for a list of possible diagnoses. Doctors appreciate when their patients are proactive, engaged, and wanting to get better, so make sure to ask
questions! And consider taking a loved one with you to the visit. They can help ask pertinent questions, write down what the doctor is saying, and provide emotional support. Maintaining our best health requires input from both ends of the stethoscope. And the benefits are well worth it!
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This article is for general information only and should not be used for the diagnosis or treatment of medical conditions and cannot substitute for the advice from your medical professional. Dr. Nina has used all reasonable care in compiling the current information but it may not apply to you and your symptoms. Always consult a doctor or other health care professional for diagnosis and treatment of medical conditions.
By Nina Radcliff, MD