Should I be concerned about my condition if two doctors (MDs) said it was fine but I'm still experiencing symptoms?

When Two Doctors Say "It's Fine" But Symptoms Persist

If two physicians have evaluated you and found no concerning pathology, but you continue to experience symptoms, this discordance warrants systematic re-evaluation rather than dismissal, as persistent symptoms despite reassurance may indicate either an evolving condition, a missed diagnosis requiring different testing modalities, or a functional disorder requiring alternative management approaches.

Understanding the Clinical Context

The disconnect between physician reassurance and persistent symptoms is a recognized clinical scenario that requires structured evaluation rather than simple acceptance 1. Several key principles apply:

Why Symptoms May Persist Despite Normal Initial Evaluation

• Timing of evaluation matters: Certain conditions have fluctuating presentations where symptoms may not be evident during examination, particularly in conditions like Ménière's disease where episodes are intermittent 1
• Limitations of initial testing: Standard evaluations may miss early disease or require specific timing to detect abnormalities 1
• Biomarker-symptom discordance: In inflammatory conditions, biomarkers like CRP may be normal despite active disease, particularly in certain anatomic distributions 1

Structured Approach to Persistent Symptoms

Document your symptom pattern systematically 1:

• Frequency and duration of episodes
• Severity and specific characteristics
• Associated symptoms that occur together
• Triggers or patterns (time of day, activities, positions)
• Impact on daily function and quality of life

This documentation is critical because diagnosis often requires multiple visits, and a detailed symptom journal significantly improves diagnostic accuracy 1.

When to Pursue Further Evaluation

Seek re-evaluation if any of the following apply 1:

• Symptoms are worsening or changing in character: This suggests either disease progression or an evolving condition that may now be more readily identifiable
• New symptoms have emerged: Additional manifestations may complete a diagnostic picture that was previously incomplete
• Symptoms significantly impact function: Persistent functional impairment despite reassurance warrants investigation for underlying conditions or functional disorders requiring specific management 2
• Symptoms occur in specific patterns: Positional symptoms, episodic symptoms with clear triggers, or symptoms that fluctuate in predictable ways may require specialized testing performed during symptomatic periods 1

Specific Considerations by Symptom Type

For Episodic Symptoms (Vertigo, Dizziness, Neurologic)

Persistent episodic symptoms require specialized evaluation 1:

• Time-specific testing during symptomatic periods may be necessary
• Video or electronystagmography can detect vestibular dysfunction not apparent on routine examination 1
• MRI with contrast may be needed to exclude structural causes 1
• Consider evaluation for conditions that simulate other disorders but require different management 1

For Inflammatory or Pain Conditions

Normal initial biomarkers do not exclude active disease 1:

• CRP may be normal in 30-40% of patients with active inflammatory disease, particularly with certain anatomic distributions 1
• Fecal biomarkers (calprotectin, lactoferrin) may be more sensitive than serum markers for gastrointestinal conditions 1
• Repeat testing during symptomatic periods increases diagnostic yield 1

For Cardiac Symptoms

Discordant symptoms and initial testing require risk-stratified follow-up 1:

• Patients with persistent symptoms despite negative initial evaluation should undergo stress testing or advanced imaging within 72 hours 1
• Serial biomarkers and ECG monitoring may be necessary for intermittent symptoms 1
• Functional assessment (stress testing, advanced imaging) is preferred over repeated basic testing 1

Critical Next Steps

Request specific additional evaluation 1:

1. Specialized testing during symptomatic periods: Many conditions require evaluation when symptoms are active
2. Alternative diagnostic modalities: If initial imaging was negative, consider different imaging techniques (CT vs MRI vs ultrasound vs functional testing) 1
3. Specialist referral: Consider evaluation by a specialist in the relevant organ system who can perform specialized testing 1
4. Functional assessment: For conditions where structural testing is normal, functional testing may reveal physiologic abnormalities 1

Important Caveats

Do not assume symptoms are "psychological" without proper evaluation 2:

• Functional disorders are real conditions requiring specific management, not dismissal
• However, functional disorders should only be diagnosed after appropriate exclusion of organic pathology 2
• Psychogenic conditions present with specific patterns (prolonged duration, gradual onset/offset, emotional distress) that differ from organic disease 2

Avoid common pitfalls 1:

• Don't accept "normal" results without understanding what was actually tested and when
• Don't assume one negative test rules out all related conditions
• Don't delay re-evaluation if symptoms worsen or new symptoms develop
• Don't accept reassurance if symptoms significantly impair your quality of life or function

When Reassurance Is Appropriate

Accept reassurance if 1:

• Multiple comprehensive evaluations including appropriate specialized testing have been negative
• Symptoms are stable or improving over time
• No high-risk features are present
• Functional impact is minimal
• Follow-up plan with specific return precautions is established

In this case, focus shifts to symptom management and scheduled monitoring rather than repeated diagnostic testing 1.