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Posted by on Dec 15, 2008 in Bioethics | 0 comments

Sign or symptom? (15.12.2008)

Sign or symptom? (15.12.2008)

When I began working in a university hospital centre, I soon noted that the terms ‘signs’ and ‘symptoms’ were being used in (at least) 3 different ways within this hospital environment. I’ve listed them in the order in which I encountered them, rather than in any specific or logical hierarchy:

  1. Interchangeably
  2. To differentiate between clinically relevant and irrelevant findings or observations
  3. To specify whether a finding or observation was noted by a clinician or by a patient

This was somewhat confusing, especially given the bilingual (English/French) nature of the university hospitals in which I was working in a research-centric capacity.

In the first category there were usually patients – along with their families and caregivers – using these two terms interchangeably. Some clinicians also used these terms interchangeably; my old pocket medical dictionary, for example, defines a symptom as “a characteristic indicator of a disease or infection, either evident to the examiner or a sensation described by the subject, that, taken with other indicators, forms the basis for a diagnosis”(1).

The second manner of using the terms signs and symptoms was fairly straightforward, although perhaps overly dismissive of patients’ self-reporting. Any observation deemed relevant – by the clinician – to the medical condition being evaluated or treated was a ‘sign’. Any irrelevant or superfluous observation would be deemed by the clinician to be a ‘symptom’, and given less weight in the medical assessment.

In the third case, the terms sign and symptom seemed to be defined separately and as different types of observations. The general distinction seemed to be that a ‘sign’ was an objective finding that resulted from a clinician’s examination or observation, laboratory testing, medical device readings, medical imaging, or the like.

One medical dictionary describes a sign as “any objective evidence of disease or dysfunction” or “an observable physical phenomenon so frequently associated with a given condition as to be considered indicative of its presence”(2).

A ‘symptom’, however, was an experience or sensation reported by a patient (or by a caregiver). The same oedema might be viewed as a sign if observed by a physician, but as a symptom when swelling was reported by a patient. If noted by each of them, it would – somewhat confusingly – be considered both a sign and a symptom.

Perhaps the clearest distinction of the third sense of signs versus symptoms is provided in the field of clinical psychology: “Signs are observable indications of a disorder, whereas symptoms are self-report of the physical or psychological effects of a disorder”(3).

Using asthma as an example, and the third set of definitions of these two terms, decide whether each of the following would be most likely to be considered a sign, a symptom, or both*:

  1. Chest tightness
  2. Coughing
  3. Coughing that wakes a patient during the night
  4. Gasping
  5. Intercostal retractions
  6. Rapid breathing
  7. Rapid pulse
  8. Shortness of breath
  9. Wheezing
View from a mountain top

Photo: Sandra Woods

~~~~~~~~~~~~~~~~~

*My replies to this challenge; yours may differ:

  1. Chest tightness = Symptom
  2. Coughing = Both
  3. Coughing that wakes a patient during the night = Symptom (unless the clinician observes the patient during sleep, which is possible in a hospital setting)
  4. Gasping = Both
  5. Intercostal retractions = Sign (unless the patient observed this in a mirror)
  6. Rapid breathing = Both
  7. Rapid pulse = Sign (unless the patient takes their pulse)
  8. Shortness of breath = Symptom
  9. Wheezing = Both

(1) The New International Webster’s Vest Pocket Medical. Trident Press International. 2001. ISBN 1582792194.

(2) TheFreeDictionary.com. Sign. Farlex Inc. Undated. Web:
http://medical-dictionary.thefreedictionary.com/sign

(3) Kraft, N. H. and Keeley, J. W. 2015. Sign versus Symptom. The Encyclopedia of Clinical Psychology. 1-3. 23 Jan 2015

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