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Treating Numbers vs. Treating Symptoms

There are many occasions when people, for lack of a better explanation, do not feel “right”.   These sensations could be more “whole body” such as fatigue, lack of energy, poor stamina and similar symptoms.  Or, they can be more body-area specific such as vague pain in a certain muscle group, a shortness of breath sensation with exertion or non-specific headaches.

A visit to the doctor for evaluation of these symptoms will (hopefully) include thorough history taking to explore past medical history, current medications, family history of medical issues and detailed explanation of the symptoms being experienced by the patient.  This is then followed (hopefully) by a complete physical examination and then, based on symptoms and the examinations, laboratory blood testing and other tests (such as x-rays, MRI, CT, ultrasound) that are needed to identify the medical issues causing the symptoms.

There are many instances when the examination, blood work and other testing do not provide a definitive diagnosis.  The patient is informed that “everything is normal”.  This is very frustrating situation for the affected patients because they clearly are feeling something that is not “normal” for them, yet the doctor cannot find anything specific to explain why those symptoms are being felt.

As a physician, I believe it is very important to NOT chalk off a patient’s symptoms to “anxiety” or “stress” just because all objective testing is not revealing a definitive organic cause.  As much as we would like to think that we, meaning the medical profession, “knows it all”, there are MANY aspects of human physiology that we not “all-knowing”.

This entry was inspired by my recent experience of seeing a number of male patients that present with lots of symptoms that would suggest testosterone deficiency, such as lack of energy, low libido, poor sexual function, etc.  The “normal” range of serum testosterone is between 260-916.  So, a male with a level of 400 would be considered “normal”.  However, when that patient is prescribed testosterone, many, if not all of the symptoms improve.  Perhaps “normal” for that person is 600 or more.  The same holds true for women transitioning through the 40s and 50s that have a number of symptoms that suggest estrogen deficiency.  Despite “normal” levels, perhaps the symptoms would be much improved if a small dosage of estrogen was provided.

If you feel that you are sort of being “dismissed” by your doctor when evaluation for your symptoms is “normal”, yet your symptoms are impacting your life, it is time to get a second opinion, hopefully from a healthcare professional that looks beyond the numbers.  We, as doctors, should not just be treating numbers, but rather, try to help improve the symptoms.

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