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Cited by 947Primary Care and Health OutcomesClinical Reasoning and Diagnostic SkillsChronic Disease Management Strategies

Common symptoms in ambulatory care: incidence, evaluation, therapy, and outcome

Kroenke, Kurt, Mangelsdorff, A.David·1989·The American Journal of Medicine
DOI 10.1016/0002-9343(89)90293-3
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Abstract

Purpose and patients and methods Many symptoms in outpatient practice are poorly understood. To determine the incidence, diagnostic findings, and outcome of 14 common symptoms, we reviewed the records of 1,000 patients followed by house staff in an internal medicine clinic over a three-year period. The following data were abstracted for each symptom: patient characteristics, symptom duration, evaluation, suspected etiology of the symptom, treatment prescribed, and outcome of the symptom. Cost estimates for diagnostic evaluation were calculated by means of the schedule of prevailing rates for Texas employed by the Civilian Health and Medical Program of the Uniformed Services for physician reimbursement.Results A total of 567 new complaints of chest pain, fatigue, dizziness, headache, edema, back pain, dyspnea, insomnia, abdominal pain, numbness, impotence, weight loss, cough, and constipation were noted, with 38 percent of the patients reporting at least one symptom. Although diagnostic testing was performed in more than two thirds of the cases, an organic etiology was demonstrated in only 16 percent. The cost of discovering an organic diagnosis was high, particularly for certain symptoms, such as headache ($7,778) and back pain ($7,263). Treatment was provided for only 55 percent of the symptoms and was often ineffective. Where outcome was documented, 164 (53 percent) of 307 symptoms improved. Three favorable prognostic factors were an organic etiology (p = 0.006), a symptom duration of less than four months (p = 0.009), and a history of two or fewer symptoms (p = 0.001).Conclusion The classification, evaluation, and management of common symptoms need to be refined. Diagnostic strategies emphasizing organic causes may be inadequate.

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  • 84% of 567 common complaints indicated no medical diagnosis.

    “One study discovered that 84 % of 567 common complaints, such as dizziness and chest pain, indicated no medical diagnosis [9].”

    From Consequences of Repression of Emotion: Physical Health, Mental Health and General Well Being (2019) · cites this paper as [9]

  • In most patients with undiagnosed physical symptoms, a DSM-IV diagnosis of psychiatric disease is not present; only 10% had an overt psychiatric illness.

    “Of note is the fact that in most of these patients, a DSM-IV diagnosis of psychiatric disease is not present; Kroenke and Mangelsdorff [3] found that only 10% of patients with the undiagnosed symptoms had an overt psychiatric illness.”

    From Treatment of somatization in primary care (1997) · cites this paper as [3]

  • In a study by Kroenke and Mangelsdorff, only 1 in 10 patients reporting 14 of the most common physical symptoms in primary care had an organic diagnosis even after extensive and costly testing.

    “In a study by Kroenke and Mangelsdorff [3], only 1 in 10 patients reporting 14 of the most common physical symptoms in primary care had an organic diagnosis even after extensive and costly testing.”

    From Treatment of somatization in primary care (1997) · cites this paper as [3]

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Authors
Kroenke, K., & Mangelsdorff, A. D.
Affiliations
  • Uniformed Services University of the Health Sciences (US)
  • Brooke Army Medical Center (US)
ORCID
Kroenke, Kurt
Venue
The American Journal of Medicine
Publisher
Elsevier BV
Published
1989-03
Volume
86
Issue
3
Pages
262-266
ISSN
0002-9343 (ISSN-L)
DOI
10.1016/0002-9343(89)90293-3
OpenAlex
W1984623074
Cited by
947
References
39
Citations by year
2026: 9 · 2025: 17 · 2024: 12 · 2023: 13 · 2022: 14 · 2021: 11 · 2020: 18 · 2019: 20 · 2018: 20 · 2017: 25 · 2016: 23 · 2015: 25 · 2014: 39 · 2013: 31 · 2012: 32
FWCI
36.80
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • The American Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
  • Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
  • Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
Keywords
common symptoms, outpatient care, symptom incidence, diagnostic assessment, treatment outcomes, organic etiology, diagnostic costs, symptom duration, prognostic factors, headache, back pain, chest pain, fatigue, dizziness, dyspnea, abdominal pain, cough, constipation, weight loss, insomnia, internal medicine clinic
MeSH terms
Ambulatory Care, Diagnosis, Disease, Female, Humans, Male, Military Personnel, Morbidity, Prognosis, Retrospective Studies

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