 |
| Training |
|
|
| Treatment |
|
|
 |
|
|
|
Common Symptoms
New or unexplained symptoms account for about half of all office visits; the remainder of visits are for ongoing care of established medical conditions. Evidence-based symptom evaluation combines knowledge of a symptom's clinical epidemiology with disease candidates according to Bayesian principles (see Diagnostic Testing and Medical Decision-Making), such that the likelihood of a specific disease is a function of patient demographics, comorbidities, and clinical features. This knowledge can help support decisions about further testing or treatment or whether to perform additional testing before treatment, or to treat without further testing.
In addition to epidemiologic factors, biological, psychological, social, and cultural factors affect how patients process, filter, and interpret symptoms. Patients vary in deciding when symptoms are sufficiently bothersome or worrisome to cause them to seek medical attention, and in what they expect from the office visit.
Many symptoms defy diagnosis. If symptom relief is not easily achieved, treatment of these patients becomes challenging. The shift toward evidence-based principles of medicine, which encourage narrow study questions in homogeneous study populations, inadvertently ignores syndromes that are not readily explained by current biomedical models of disease. Conversely, even when the cause of a disease is known, host and environmental factors can influence the symptoms that are manifested. For example, in 1967, Evans proposed five "realities" that reflect the conundrum clinicians face when associating an acute respiratory syndrome with an etiologic pathogen: (1) The same clinical syndrome may be produced by a variety of infectious pathogens; (2) the same pathogen may produce a variety of syndromes; (3) the most likely cause of a syndrome may vary by patient age, year, geography, and setting; (4) diagnosis of the pathogen is frequently impossible on the basis of clinical findings alone; and (5) the causes of a large proportion of infectious disease syndromes are still unknown.
|
 |
Healt Tips |
|
|
|
