When You're Sick, But the Tests Show "Normal"
Author: Mark A. Stafford, M.D.

Have you ever been to the doctor with a set of symptoms that concerned you and after completing the evaluation been frustrated and perhaps a little embarrassed when the doctor looks at you blankly and says all your tests are normal? “How could they be normal!??you think to yourself. You begin wondering if perhaps the doctor thinks you are a hypochondriac. Maybe he/she thinks you are seeking sympathy or attention. But the nagging ache in your lower back or stomach reminds you that you are not imagining your pain. No, this is real! You muster your courage, swallow hard and assert yourself. “If my tests are normal, then what is wrong? What am I supposed to do??You anxiously try to read your physician’s response, looking for hope and understanding.

Unfortunately, all too often the doctor returns your look with yet another sterile answer that everything seems to be fine. What gives? Well, take heart, dear patient. You are not alone. Several years ago, Dr. Kurt Kroenke carried out a fascinating study in a general internal medicine clinic caring for military personnel and their families. He studied approximately 1,000 patients over three years, carefully cataloging their most common symptoms causing them to seek medical attention. He then collected a list of the 14 most common symptoms (chest pain, fatigue, dizziness, headache, swelling, back pain, shortness of breath, insomnia, abdominal pain, numbness, erectile difficulties, weight loss, cough, constipation), while a separate group of reviewers looked at the records to see what the evaluation of such symptoms uncovered after the three years of follow-up. The results were fascinating! Remarkably, a definite cause could be found only 16% of the time! In another 10% the cause was felt to be psychiatric. Amazingly, in 74% of the cases no cause could be found for the symptoms!! Fortunately, in most of the cases, within a few weeks the symptoms resolved spontaneously without adverse consequences.

This study confirms what seasoned primary care physicians have long observed. In ?of the patients presenting with common symptoms-symptoms that are real-no definite cause is ever found, yet most of these patients recover. I have pondered this finding for years and struggled to help patients understand what is going on. Such findings are particularly unsettling in a culture that has promoted modern technology and medical science as the answer to what ails you. “Find it and fix it?is the battle cry! Like a broken machine, we mistakenly believe for every problem, finding a competent doctor and the right hospital or clinic will produce the correct answer.

After twenty years of practicing medicine, I have made the following observations:

Medical science has come far but is still in its infancy when it comes to understanding symptoms. Symptoms result when chemical, nerve and hormone reactions interact with our brain and mind. Symptoms are always real and must be taken seriously for they may hold clues to the early detection of disease. Illness is not the same as disease. Illness is how you feel and act when you are sick. Disease is the term we give specific causes of illness. For most illnesses, we do not understand the science well enough to define the disease. Our bodies have a remarkable capacity to heal themselves if we are patient. We would do well to avoid the risk of a doctor’s treatment and possible side effects unless our symptoms last several weeks. An ongoing, therapeutic relationship with a concerned, well-trained physician increases the chance a serious cause for persistent symptoms will be discovered, given time and careful observation. Getting frustrated and “doctor shopping?means no one doctor ever really gets to know you so subtle changes can be detected. Someday, somewhere, somehow, we may understand why some people have some symptoms. Doctors used to think too much acid instead of bacteria caused ulcers. Medicine is an inexact science.

So the next time you confront your doctor with a set of troublesome symptoms, the tests are normal and your questions are met with a blank stare, remember: you are not crazy. Your symptoms are real. Give yourself time to heal. Ask your doctor for medication to help relieve your symptoms. If your symptoms persist for several weeks, return to a trusted, intelligent, compassionate physician for a reevaluation. And follow up. Tests are just tests. They can be wrong or your problem may be too early to diagnose. Meanwhile, find time for rest, renewal and laughter. Hope is powerful medicine. Time is a great physician.

Dr. Mark

Reference: Kroenke, K., et.al. Common Symptoms in Ambulatory Care: Incidence, Evaluation, Therapy, and Outcome. The American Journal of Medicine. Volume 86. March 1989. p. 262-266.

Mark A. Stafford, M.D., F.A.C.P. Find Out More About the Author

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*The information contained in these articles is not intended nor implied to be a substitute for professional medical advice. Always ask your physician or other qualified health professional about any matter concerning your individual health. Always seek the advice of your physician prior to starting or changing any medical treatment. Nothing contained in these answers is intended for medical diagnoses or treatment purposes.

COPYRIGHT NOTICE: The material in this section is copyrighted by the University of Alabama Board of Trustees for the University of Alabama at Birmingham. Permission to reprint or electronically reproduce any document or graphic in whole or in part for any reason is expressly prohibited, unless prior consent is obtained from the publisher.








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UAB Kirklin Clinic
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Clinic Address: 2000 6th Avenue South
Office Address: 612 MEB; 1813 6th Avenue South; Birmingham, AL
35294-3296
Appointments: (205) 934-9999
Office: (205) 934-1930

Specialty: General Internal Medicine

Faculty Appointment: Associate Professor

School of Medicine: University of Alabama School of Medicine, 1978

Internship/s: University of Alabama Hospital - From 1978 To 1979

Residency/ies: Internal Medicine: University of Alabama Hospital - From 1979 To 1981; Chief Medical Resident and Instructor - From 1981-1982; PGY-2 General Surgery Residency - From 1992-1993

Certification/s: Amer. Bd. of Internal Medicine Board Certified, 1981

Interests: Teaching and improving communication skills. Dedicated to helping others improve their quality of life.

Languages Spoken: English

Dr. Stafford is a board certified physician in the practice of Internal Medicine. He attended medical school and completed his residency at the University of Alabama at Birmingham. After ten years in private practice in Dothan, Alabama, Dr. Stafford returned to UAB to teach in the Primary Care Internal Medicine Residency Teaching Program.

Dr. Stafford divides his time between teaching and primary care here at UAB.

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