ALEXANDRIA, Va. -- Helping patients communicate their symptoms clearly could go a long way toward making an accurate diagnosis, John Ely, MD, MPH, said at the annual meeting of the Society to Improve Diagnosis in Medicine.
Ely, a family physician who is retired from the University of Iowa in Iowa City and has been a patient himself recently, said he "got to thinking about what a good patient would do." One of the things professors teach medical students is the eight characteristics of a symptom.
"Patients don't know what these eight things are, I don't think," but there's no reason they shouldn't know, Ely said during a session at the meeting about how to get patients more involved in getting an accurate diagnosis.
The eight characteristics listed by Ely included:
- Where is your pain or numbness? This obviously wouldn't work for more generalized symptoms like fatigue or shortness of breath.
- How long have you had the symptom? If it's something intermittent -- like a spell of chest pain -- how often does it happen and how long does it last? Is it gradually getting worse? Getting better? Staying the same?
- What were you doing when you first noticed the symptom? Were you just sitting there? Arguing with someone? This is particularly important if the patient is having dizziness, Ely noted.
- Are any other symptoms associated with this one -- for example, light-headedness or shortness of breath?
- What is the "quality" of the symptom -- what does it feel like? "Patients sometimes say to me, 'What do you mean? It's just a pain, doc.' Well, is it like an elephant stepping on your chest, a fire in your chest, someone stabbing you with an ice pick, or what? I want to stay open-ended as long as possible, so [I usually say] 'Just tell me ... what it feels like,'" said Ely.
- What is the "quantity" of the symptom -- for example, how bad is it on a scale of 1 to 10?
- What aggravates the symptom?
- What alleviates the symptom?
Basically, physicians want to know a patient's chief complaint, "and then we want a paragraph -- not six paragraphs and not a novel -- and in that paragraph you need to tell the doctor these eight things," he said.