What is causing my symptoms?

Understanding Your Symptoms: A Diagnostic Framework

Based on the vague nature of your question "What is it?", you are likely experiencing symptoms that are difficult to characterize or don't fit a clear pattern. The most critical first step is to provide your physician with precise, medically-defined descriptions of your complaints rather than vague terms, as poor symptom characterization dramatically reduces diagnostic accuracy and leads to unnecessary testing, increased healthcare costs, and potential harm from cascade interventions 1.

Why Precise Symptom Description Matters

• Vague complaints lose most of their discriminative power as diagnostic tests, forcing physicians to consider multiple competing interpretations for identical complaints 1.
• When physicians are uncertain about symptom meaning, this "test degeneracy" diminishes the value of the symptom and requires many more tests to confirm or exclude diagnoses 1.
• Poor medical histories expose patients to more test-related risks, prolong the diagnostic process, and increase healthcare expenditures 1.
• Primary care physicians estimate that 10-20% of their patients present with unusual or unexplained symptoms that are difficult to diagnose 2.

The Action Bias Pitfall

Physicians facing uncertain diagnoses demonstrate "action bias"—preferring workups over watchful waiting (87% vs 13%)—even when their confidence in management approaches exceeds their confidence in the actual diagnosis 2.

• This bias can lead to cascade iatrogenesis, where one intervention leads to complications requiring further interventions, creating a chain of adverse events 3.
• When causality cannot be established through post-hoc reviews, it becomes impossible to know whether changes will prevent future errors 3.

How to Provide Useful Symptom Information

To help your physician make an accurate diagnosis, describe:

• Exact location: Point to the specific area (e.g., "left lateral chest wall between ribs 9-10" rather than "chest pain") 4, 5.
• Quality: Use descriptive terms like burning, sharp, dull, aching, pressure, stabbing 4, 5.
• Timing: When it started, duration, constant vs intermittent, time of day patterns 6.
• Aggravating/relieving factors: What makes it worse (movement, breathing, eating, stress) and what makes it better (rest, position changes, medications) 6, 4.
• Associated symptoms: Any other symptoms occurring simultaneously (fever, weight loss, blood in stool, changes in bowel habits, mood changes) 6.

Common Symptom Patterns and Their Implications

If You Have Abdominal Discomfort with Bowel Changes

Irritable bowel syndrome (IBS) requires at least 12 weeks of abdominal discomfort with 2 of 3 features: relief with defecation, onset with stool frequency change, or onset with stool form change 6.

• IBS symptoms have physiological basis involving altered gut reactivity, visceral hypersensitivity, and brain-gut axis dysregulation 6.
• Psychosocial factors (stress, abuse history, psychiatric comorbidity) are not diagnostic criteria but influence clinical outcomes and treatment planning 6.
• Red flags requiring investigation include fever, weight loss, blood in stools, anemia, or abnormal physical findings 6.

If You Have Chest or Rib Pain

For lateral rib pain, the most common causes are rib fractures (40% of trauma patients), costochondritis, muscle strains, or nerve entrapment, but life-threatening cardiac and pulmonary causes must be excluded first 4, 7, 5.

• Burning sensation around ribs in young adults without exertional component is extremely unlikely to be cardiac 5.
• Reproducible chest wall tenderness on palpation, normal vital signs, and absence of respiratory distress are sufficient to exclude emergent causes in low-risk patients 5.
• Ultrasound is preferred over chest X-ray for costochondral junction injuries, as radiographs miss up to 50-90% of these fractures 4.

If You Have Mood or Cognitive Symptoms

Major depressive disorder requires 5 or more specific symptoms present for the same 2-week period, with at least one being depressed mood or loss of interest/pleasure 6.

• Symptoms must cause clinically significant distress or functional impairment 6.
• Symptoms must not be due to direct physiologic effects of substances or medical conditions (e.g., hypothyroidism) 6.
• Recognition of depression should trigger referral to a mental health provider skilled in treating your age group 6.

If You Have Functional Neurological Symptoms

Functional disorders are diagnosed based on positive clinical features (inconsistency, internal inconsistency, inefficient movement patterns) rather than simply excluding organic disease 6.

• Symptoms may be inconsistent with examination and imaging findings, or show internal inconsistency (resolution when attention diverted) 6.
• A biopsychosocial model identifies predisposing vulnerabilities (genetic, personality traits, adverse life events), precipitating mechanisms (physical injury, emotional stress), and perpetuating factors (fear-avoidance, hypervigilance) 6.

What Your Physician Should Do

• Perform focused physical examination looking for specific positive findings rather than just excluding diseases 6, 5.
• Assess for alarm signs requiring urgent investigation 6.
• Avoid unnecessary testing when clinical probability is low, as this increases risk of false positives and cascade interventions 1, 2, 3.
• Consider symptom clusters rather than isolated complaints, as co-occurring symptoms (fatigue-pain-depression-sleep disturbance being most common) may share underlying mechanisms 6.

Critical Caveat

If you cannot clearly articulate your symptoms, work with your physician to translate vague complaints into precise, medically-defined terms before pursuing extensive testing 1. This single step will dramatically improve diagnostic accuracy, reduce unnecessary procedures, and lead to more appropriate treatment.