Sometimes as a nurse, I wish I could live in a Star Trek episode and pull out my tricorder, grabbing my assessment with a quick hover of the device over my patient. Those crafty gadgets could tell you everything about your patient. Unfortunately, we aren’t blessed with these yet so it’s good academia to know the difference between a sign and a symptom when writing a medical scene.
Any guesses as to what the difference is?
A symptom is something subjective felt by the patient and told to the nurse or physician. It is not measurable. For instance, a person coming in with abdominal pain might say: “I feel like I’m going to throw-up. It feels like someone is stabbing me in the gut with a knife!” All of these things the patient describes are symptoms. We can’t measure them and we only know they’re present because the patient tells us so.
A sign in the medical sense is something we can measure or directly observe. Let’s take the same patient from above. He has relayed to the medical staff that he is having some pain. Some signs of pain are sweating (diaphoresis), increased heart rate (tachycardia), and increased blood pressure (hypertension). Some patients might writhe around in pain. These we can observe and measure.
Now to throw a wrench into my definition. At times, we try to measure symptoms like pain. This is why we have pain scales. A patient states they’re having pain. The nurse replies: “Sir, on a scale of 0-10, zero being no pain and ten being the worst pain you’ve ever had in your entire life, how bad is your pain?” We attempt to measure but it is still the patient’s subjective experience.
Here’s a very common ER set-up that can increase conflict between the patient and the medical staff.
A patient presents to the ED with complaint of a headache. There are several patients to be triaged and the person takes a seat in the waiting room. He strikes up conversation with another family. After that, he puts his ear buds in and is texting on his phone. I can see that this patient has signed in and what his complaint is on my computer screen. I decide, based on his complaint and his behavior in the waiting room, he’s okay to wait for me to triage the other patients.
In triage, he continues to complain of a headache. He is warm and dry. Sits comfortably. Heart rate and blood pressure are normal. I ask him to rate his pain. “It’s 15/10. This is the worst headache of my entire life!”
See the conflict? Do you believe this patient is in pain? If yes, why? If no, why?
***Content reposted from January 26, 2011.***
3 thoughts on “Signs Versus Symptoms”
Jordyn, I love these posts of yours. Keep ’em coming! I, too, wish you had one of those tricorder things to diagnose people with. It would make things a lot easier. My pastor’s wife is going through some horrible symptoms, issues, etc and has already been through several surgeries, many tests and is still not well. Those devices could tell them exactly what her problem is.
Re the guy with the headache: I don’t think he’s having the worst pain of his life. If you can sit there and listen to music and talk with other people, that’s a telling sign. In my non-medical opinion. I’ve been having hormonal headaches since I started perimenopause in 2005 and when they are bad, I can’t talk and carry on like nothing is going on. One day, this will stop. However, I’m curious to know what you think about headache dude.
I, like you, don’t think he’s having the “worst headache of his life” and probably wouldn’t believe him if he said his pain was 10/10. But I will also say that we are taught that the patient’s pain is what they say it is. However, I think all of us know that patients in severe pain cannot even sit still. Some patients with chronic pain disagree with this statement and I respect that– I’ve never had a chronic pain issue– at least a severe one.
Since doctors are encouraged to treat the pain as the patient says it is, this led to a huge increase in narcotic prescriptions (mostly led by the government entity that regulates hospitals). This increase in giving prescription medications has also led to a huge increase addiction to illegal drugs. So, was it before that we didn’t adequately treat pain? Or were we because as healthcare providers we can also make objective assessments as to how much pain a person is in.
The answer is probably somewhere in the middle.
As someone with chronic pain from multiple autoimmune diseases and neck issues, I kind of agree. There are times I have severe pain, but can quasi function. When the pain is at 9-10, I don’t function at all.
On the other hand, I have a friend who was having a massive MI, went into the ER and told them her chest pain was a 10. The nurse told her she couldn’t be sitting quietly answering questions if her pain was that high. Soon after the comments, my friend collapsed into cardiac arrest.
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