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Sorting out health concerns

By: Mike Harlos MD, CCFP(PC), FCFP

Sorting out health concerns

When health care providers are faced with a health concern, they try to sort out what could be causing the problem. Treatment will vary from person to person, depending on the cause of the concern. For example, someone who is nauseated could be feeling sick as a result of:

  • side effects from pain medication
  • constipation
  • toxins built up in the body
  • high levels of calcium in the blood
  • anxiety.

Generally the health care team will try to determine the cause of the problem to help decide what treatment would be most appropriate.

In order to sort out most health care concerns, three basic steps are followed. The health care team will ask questions, conduct a physical examination, and order some tests if necessary. 

Questions from the health care team

The health care team will ask for as much detail as possible when asking a person to describe symptoms.  A thorough understanding of the symptoms often helps to identify what may be causing them.  These are some typical questions:

  • How do you feel? Describe the symptoms.
  • When did the symptoms first appear?
  • Have you ever had them before?
  • Are the symptoms steady and ongoing, or do they come and go? Is there a pattern?
  • What brings on the symptoms, or makes them worse?
  • What helps the symptoms, or even makes them go away?
  • Sometimes people notice that one symptom tends to be connected with another symptom, for example whenever they have pain they feel nauseated. Does something like this happen?
  • What medications are you taking? How long have you been taking them?
  • How does the medication seem to be working?
  • Are there any problems with the medications (side effects, trouble taking them, difficult schedule, too expensive)?

Physical examination

A physical examination is usually the second step to narrowing down some of the possible causes of symptoms. In many ways, the physical examination helps confirm or rule out what is indicated by the person's answers to the questions above. For example, if someone describes a sore stomach, examining the stomach will help to confirm or exclude specific possible causes of the discomfort. The doctor or nurse will be looking for physical signs, such as these:

  • swelling of parts of the body
  • tenderness
  • evidence of muscle weakness
  • changes in skin colour
  • changes in sensation.

Tests

Tests such as X-rays, blood tests, and urine samples often help to provide more information about what might be causing the symptom. Tests can either eliminate or confirm potential causes of the symptoms. Anemia, for example, can quickly be diagnosed when blood tests reveal that red blood cell counts are too low. But, many times, there is no test that can pinpoint the cause of the problem. Constipation, for example, can be caused by many different factors, including medications taken for pain or a decrease in activity, eating or drinking. Because tests cannot always detect the source of the problem, health care teams place great emphasis on both the physical examination and taking a careful history of the patient’s symptoms.

Sometimes the health care team will not be able to say for sure what is causing the health concern. This particularly may be the case when the symptom is quite general, such as fatigue. In such a case, the team will likely try different treatment options, or a combination of approaches to see which ones seem to help relieve the symptoms.

It may seem at times as if the team is just using a trial and error approach, or is experimenting with different possible treatments. In fact, the trials of different treatments are guided by the training and experience of the health care providers, and are not simply guesses at what might help. Every patient brings unique elements to a situation, and a very individualized approach must often be taken in trying to help sort out and treat symptoms.

Content reviewed October 2017