As physicians, we evaluate patients based on many parameters including the “symptoms” a patient presents with as well as objective laboratory/radiology testing. It is sometimes the case that the symptoms of the patient are more important than the “numbers” (lab test results) whereas at other time, the lab testing is actually more important to address than the person’s subjective state of well-being.
Here is an example: If a patient came to me for a routine general check up and states: “Doctor…I feel great….I could not feel any better”, but I find a blood pressure of 220/120 (dangerously high), a hemoglobin A1C of 12.0 (indicative of severe diabetes) or kidney function tests showing moderate-severe renal insufficiency, I am immediately starting medications, ordering further testing and in other ways, acting with immediacy/urgency. The patient will be taken aback stating…”Hey Doc….what is the commotion, I feel great!”. The problem is that those aforementioned “numbers”, despite the patient feeling no symptoms, are dangerous and may cause worsening illness leading to early death.
Conversely, if a patient presents such as a man complaining of low libido, low energy, and muscle weakness as symptoms, but the lab testing shows a “normal” testosterone level of 300 (normal is 264-916), I am still recommending testosterone replacement treatment for this patient despite the “normal” number. However if a man has zero symptoms and has a lower than normal testosterone level I am not recommending treatment for that patient because having a low “number” in this case does not place this patient at health risk.
The point of today’s entry: We cannot always rely on symptoms we experience to alert us about potential severe disease and conversely sometimes “numbers” being out of the normal range do not necessarily predict serious disease. Proper evaluation requires the evaluation of a patient’s symptoms, ordering the appropriate testing and then make the determination of what is the best course in addressing the symptoms and/or abnormal numbers.
And the lonliest number? Ask “Three Dog Night”.
