Duration and severity

Duration
Symptoms and Signs

Course

Many symptoms presented to the doctor are not specific to any particular serious illness. They might represent a serious problem but the majority do not. In this situation the duration of a symptom is a major guide to the action taken by the doctor

Duration

At the start of a consultation each doctor is trying to rule out the serious and then can move onto a working diagnosis. Non specific symptoms presented to a doctor within an hour of onset are unlikley to require action unless the person is very unwell. For example ,a patients who presents to their GP with an hour of ear ache, or headache or sore throat or tiredness or bloating can only be advised to wait and see how the symptoms progress as it is too early to say what will happen. At the other extreme symptoms present for a few years are unlikley to be serious as any significant cause would have declared itself beforehand.

It becomes more difficult as the duration of symptoms increases from one day to three days to a week. The most difficult time is a duration between one month and four months. Over this period non specific symptoms such as tiredness, bloating or non specific pains can present as a warning of serious illness. By then the minor causes have been filtered out by the passage time. Any virus should have resolved, or the sprain should have healed.

As well as overall duration the duration of each episode of symptoms is important to check. It makes a large difference in management if the chest pain is fleeting brief and only lasts a few seconds once a month as opposed to several hours of chest pain. Asking this question can quickly clarify the course of treatment and rapidly resolve concerns.

Symptoms and Signs

Duration is only a key guide a doctors approach when the symptoms are non specific and there are no signs to be found. A doctor will pick up important clues within the first 60 seconds of the consultation. Observing how a person walks into the room, how well they look, their complexion, their breathing rate will heighten concerns or reduce concerns for the doctor. Within 60 seconds the history usually gives enough information to categorise the illness as self limiting or serious. Clearly chest pain, calf pain or swelling, and severe breathing problems require immediate action irrespective of duration. Blood pressure and pulse are key measurement that move the diagnosis into the serious category or hold it in the less serois category if they are normal

Course

When the duration is short and symptoms are non specific it is time that will be used to treat and diagnose the problem. The course of the illness will guide the next steps. An illness that resolves steadily or fully is unlikely to require further investigation. An illness that persists or worsens will require the next stage of assessment such as blood tests or surgery based investigation. Surprisingly people do attend the doctor saying “their problem has fully resolved,  but they thought it best to check”. Equally some patients need clear instructions to reattend if symptoms persist. An example being acid stomach and dyspepsia pains, which usually resolve, but need tests to fully exclude stomach ulcers or cancer if they persist