What to do when symptoms are difficult to see or measure

Physicians depend on the measurability and empirical verifiability of symptoms. Still, some symptoms defy observation and measurement, which can cause patients with a wide variety of conditions—including chronic fatigue syndrome, endometriosis, fibromyalgia, many psychiatric illnesses, multiple sclerosis and post-concussive syndrome—to suffer disadvantage and injustice if their physicians don’t take their reported symptoms seriously.

The July issue of AMA Journal of Ethics^® (@JournalofEthics) investigates the ethical, clinical and social stakes of failing to view patients as authorities about their bodies and illness experiences. It also offers CME credit.

Articles include:

1. "When Symptoms Aren’t Visible or Measurable, How Should Disability Be Assessed?"

   1. Patients writing daily journal briefs about work-related activities and pain can help clinicians help them.

2. "When Imaging Data Contradict a Patient’s Self-Report, How Should Clinicians Proceed?"

   1. Patients’ perceptions of how much input they have in making health decisions influence therapeutic alliance and outcomes.

3. "How Pharmaceuticals Mask Health and Social Inequity.”

   1. Pharmaceuticals make symptoms and biological drug targets more visible but can render individual and community suffering less visible.

4. "Bisexual Women’s Invisibility in Health Care.”

   1. Invisibility of racial inequity and gender inclusion in clinical research means key features of disease etiology and symptom presentation are unaccounted for.

One of the journal’s July podcasts explores the invisibility of chronic pain. Nurse Kim Christiansen, RN, a lactation consultant at Amita Health Resurrection Medical Center, in Chicago, discusses her experiences managing limited mobility and chronic pain from a partial spinal cord injury, and physical therapist Natalie Hoff describes good physical therapy care for patients with chronic migraine headaches.

A second “Ethics Talk” podcast features an interview with Nat Mulkey, MD, who works with faculty on LGBTQ+ curricula in undergraduate medical education, and Carl G. Streed Jr., MD, MPH, research lead in the Center for Transgender Medicine and Surgery at Boston Medical Center. The two discuss an article they co-wrote for the July issue, "A Call to Update Standard of Care for Children With Differences in Sex Development."

Listen to previous episodes of the podcast, “Ethics Talk,” or subscribe in iTunes or other services.

These AMA Journal of Ethics CME modules are each designated by the AMA for a maximum of 1 AMA PRA Category 1 Credit™:

• When Symptoms Aren't Visible or Measurable, How Should Disability Be Assessed?
• A Womanist Approach to Caring for Patients With Empirically Unverifiable Symptoms
• How Should Clinicians Minimize Harms and Maximize Benefits When Diagnosing and Treating Disorders Without Biomarkers?
• Questioning Biomedicine's Privileging of Disease and Measurability
• How Pharmaceuticals Mask Health and Social Inequity
• Invisibility of “Gender Dysphoria”
• Bisexual Women's Invisibility in Health Care
• Depression's Problem With Men

Additionally, the CME module “Ethics Talk: The Invisibility of Chronic Pain” is designated by the AMA for a maximum of 0.75 AMA PRA Category 1 Credit™.

The offering is part of the AMA Ed Hub™, an online learning platform that brings together high-quality CME, maintenance of certification and educational content—in one place—with relevant learning activities, automated credit tracking and reporting for some states and specialty boards.

The journal’s editorial focus is on commentaries and articles that offer practical advice and insights for medical students and physicians. Submit a manuscript for publication. The journal also invites original photographs, graphics, cartoons, drawings and paintings that explore the ethical dimensions of health or health care.

Upcoming issues of the AMA Journal of Ethics will focus on economic decision modeling in health care, implantable material and device regulation, and palliative surgery. Sign up to receive email alerts when new issues are published.