Symptoms and symptom presentation.

In the theory of medicine, symptoms are logically related to defined bodily derangements. In the practice of medicine, doctors see patients who experience and present their symptoms in a personal way. With the twofold aim of investigating the clinical significance of this gap and of tracing a practice oriented diagnostic competence, a study was conducted. Thirty-three general practitioners and eleven trainees and locums in primary care made diagnostic judgements, first from 16 symptoms presented in a concentrated written form, and then from the video-recordings of the actual presentations of the same symptoms. The hypothesis formulated was that doctors would increase their diagnostic accuracy after having seen the video-recordings. In the view of doctors, psycho-social causes became more important to their diagnoses after they had seen the video-tapes. When compared to the judgements made by a reference group of three general practitioners who had access to all clinical data on the patients, this change implied an increase of discrepancy of opinion (p < 0.00003) in symptoms of predominantly organic origin. This change was observed irrespective of clinical experience and sex of the doctor. Thus, the gap between theory and practice seems to be significant in terms of diagnostic judgement, but the hypothesis regarding the effect of a possible practice oriented competence could not be confirmed. On the contrary, psycho-social stereotypes regarding patients seem to have a considerable impact on early judgement. Emotional expressions and social characteristics become the targets of diagnosis rather than being regarded as integrated aspects of the symptom presentation.