HealthDay News — At least one-third of common symptoms do not have a disease-related explanation, according to a review published in the Annals of Internal Medicine.

Although physical symptoms account for more than half of all outpatient visits, the main disease-focused model of care is inadequate for many of these visits, wrote Kurt Kroenke, MD, of Indiana University in Indianapolis.

A clear-cut disease-based explanation is lacking for at least one-third of common symptoms, while history and physical examination contribute most diagnostic information, with a smaller contribution for testing and procedures.

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A dualistic approach is impractical, according to Kroenke, because physical and psychological symptoms often co-occur. Most patients have multiple symptoms, and providers should not only treat one symptom.

In most patients, symptoms improve in weeks to months, but in 20% to 25% of patients they can become chronic or recur. During long-term follow-up, serious causes that were not apparent after initial evaluation rarely emerge.

Some behavioral and pharmacological treatments are effective for multiple symptoms. Valid scales can be useful for measuring treatment response. Communication has therapeutic value, including in terms of providing an explanation and possible prognosis, added Kroenke.

“The amount of clinician training dedicated to understanding, evaluating, and managing common symptoms is disproportionally small relative to their prevalence, impairment, and health-care costs,” wrote the author.


  1. Kroenke K. Annals of Internal Medicine. 2014; doi: 10.7326/M14-0461