Many doctors’ offices have a litany of posters lining their reception and examining rooms – so many in fact that the average reader would have difficulty discerning what is most important.
For this reason, I prefer to keep my posters to the essential.
For the past 10 years, each of my examination rooms has a single poster highlighting alarm symptoms. It summarizes the symptoms that might indicate a serious medical condition requiring immediate attention.
All family doctors have had patients who – after presenting a long list of problems that we do our best to address completely – add on an alarm symptom just as they are leaving.
“By the way, doctor, I’ve been getting this chest pain every time I exercise . . .”
This is when the doctor’s heart rate goes up perhaps along with blood pressure, but I can’t be sure of the latter because I’ve never checked my own pressure when I’m trying to help a patient.
The above example suggests angina – chest pain or pressure (that may also be experienced in the throat or either arm) provoked by exercise or anxiety and relieved by rest. It could be a sign of ischemic heart disease – where a major artery supplying cardiac muscle is critically narrowed.
Obviously, serious symptoms must be dealt with right away. The doctor will need to take a detailed history, complete a careful examination and propose investigations and treatment.
Here is my list of alarm symptoms.
- PAIN: pain that is unexplained, severe, colicky, electrical or persistent; chest pain, especially if it is squeezing or associated with sweating, nausea or radiation into the neck or arm; bone pain, especially if it is unremitting and disturbs sleep.
- LOSS OF FUNCTION: unexplained changes in speech, memory, emotions, swallowing, bowel movements, urination, heart rhythm, vision, hearing, balance, coordination, sensation or muscle function.
- CONSTITUTIONAL: unexplained sudden or progressive changes in weight, body temperature, energy, appetite, thirst, leg swelling and exercise tolerance.
- GROWTHS: new or growing lumps felt in the skin, mouth, muscle, breast or scrotum; lymph nodes felt around the neck and under the arms; skin changes, including ugly moles, persistent scabs or sores.
- BLEEDING: in urine, sputum, stools (which can appear tarry black with bleeding peptic ulcers) or vomit. Nosebleeds that are recurrent or prolonged require medical attention.
Many may think that it’s common sense to seek immediate medical attention with these symptoms.
One of my patients failed to report blood in his urine for over one year. By then, he presented with the behavioural symptoms of cancer that had metastasized from his bladder to his brain.
More recently, an elderly patient reported a 50 lb weight loss and progressive difficulty swallowing. Although they began 5 months earlier, he did not report these symptoms of stomach cancer until now.
Health literacy varies widely in our diverse society. We each have different personal alarm settings. Intelligent people may ignore worrisome symptoms because of their fears.
My intention is not to raise anxiety. Much of the time, the above alarm symptoms have innocent causes. However, they may also be harbingers of serious conditions, including heart attacks, strokes and cancer.
They therefore require timely medical attention. The poster in my office requests my patients to bring these symptoms to my attention at the beginning of a visit. An alarm symptom may require extra time to evaluate and we may need to postpone dealing with less serious problems.
If you are having symptoms of a heart attack or stroke, don’t wait for a doctor’s appointment . . . or even a taxi. Call 911.