Signs Versus Symptoms

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.***