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Why Patients Struggle to Express Symptoms

For physicians, routine is a disguise. Performing multiple examinations a day, they grow used to the sterile walls, billowing gowns and murmured concerns of their visitors. But for the person on the other end of the equation — the patient — trying to describe what’s wrong can be an exercise in frustration.

“Some symptoms, like pain, can be notoriously amorphous,” says Danielle Ofri, M.D., a practicing internist and author of the communication guide What Patients Say, What Doctors Hear. “That’s coupled with patients already being under a lot of stress by virtue of the fact they’re not feeling well and worried.”

Ofri believes it can be hard to generalize symptoms due to patient demographics and the chance of a communication gap. Older people, she explains, might simply have more experience with doctors and be more comfortable sharing concerns —or they might not.

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Gender, however, is more of a possible determining factor. In a 2014 study published in the Canadian Journal of Cardiology, lead author Catherine Kreatsoulas asserted that women tend to describe symptoms of cardiac events differently from men because of a perception that heart attacks are of greater concern to males. They might be reluctant to describe it as “chest pain,” even when that would be the most succinct statement they could make.

“Women don’t believe a heart attack is part of their construct,” Ofri says. “It’s thought of as a male disease. Their pain could be a heart attack, but they just don’t think of it that way.” Women also tend to downplay issues regarding mental health, eating disorders and domestic violence. Men, Ofri says, grow reserved when discussing depression or sexual issues like erectile dysfunction.

This reluctance to share symptoms can grow when patients are nervous or feel rushed, possibly as the result of another physician having hurried them along in the past. One recent study found patients speak an average of 12 seconds before being interrupted by a caregiver. How can physicians overcome these hurdles to get the information they need for a proper diagnosis?

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“First, I would advise physicians to take that first minute to close their computer and engage the patient directly,” Ofri says. In doing so, doctors remove a barrier that can make patients feel separated from their own examination. Second, Ofri advises “normalizing” suspected ailments by asking about specific areas of the body. “I’ll ask about [a patient’s] stomach, their breathing, their sexual orientation. For example, I might say, ‘Do you have sex with men, women or both?’” The implication is that Ofri has no moral objection to any of the choices, freeing a patient to explain their issues without fear of being judged.

Ofri will also use a physical exam to tease out any lingering concerns. By touching or probing a particular area and asking if there’s discomfort, patients can focus on a direct question. Using more pointed queries can also help differentiate symptoms when it comes to patients experiencing anxiety. “If someone says their heart is pounding, I’ll ask if they mean it’s pounding harder or faster [than usual]. Harder usually means anxiety,” Ofri explains.

Ultimately, doctors can’t do a whole lot about the discomfort of an exam room. “It’s a kind of alien place,” says Ofri. But a physician who bears in mind that what may be routine for them is unusual — or even uncomfortable — for patients stands a much greater chance of resolving the problem.