Solving the puzzle: Patient symptoms and its diagnosis

Saba Khan

What the patients say?

Patients tend to say things, like narrating their symptoms in such a way that may be misleading. A health professional should be competent enough, not to be misled and reach the correct diagnosis. The narration of symptoms should be looked at, in context of the culture, literacy and conditioning of the patients. Let us start by discussing a few examples.

A female patient in her mid thirties, came to me once and said that she has urinary incontinence for the past two weeks. While taking history I asked questions relevant to the symptom mentioned. But strangely enough, she neither had burning micturation nor any history of surgical procedure in that particular area. She was coughing and on auscultation, her chest was wheezy. It was a tell tale story that the urinary incontinence was due to her cough, which was the consequence of a chest infection or mild asthma. So apparently, the patient was not bothered by the cough, she was more concerned about her incontinence.

What matters most to a patient? A symptom that they cannot understand or a symptom that is apparent? In another scenario, a female in her late twenties visited and complained about excessive nausea, the whole day long. She was insistent on having some stomach problem. I asked whether she was taking any contraceptive method? She denied. I asked when was the last time she had her periods. She said, “Two months back”. I asked, whether her cycle was regular? She said, “Yes, its monthly’. She was a mother of two. It was obvious, she was expecting. But it did not even cross her mind, because she was more concerned about her nausea than the idea of bearing a child. She later on mentioned, that the nausea in her previous pregnancies was not that pronounced and she was worried why is she feeling this way? The thought of being pregnant did not cross her mind, strangely enough.

This shows that patients leave a lot of riddle solving to their physicians, even in straight forward situations. It differs from culture to culture, but a physician has to put all the pieces of a puzzle together, without little help, to get the complete picture. It also holds true for physical complaints as a result of mental ailments. The vigilance of a physician can save a lot of time and money in such cases.

Picture courtesy by 'Pixaby'