Table Of ContentFor every symptom, the user of
The Common Symptom Guide
must always ask the following
descriptors:
1
The patient’s age.
2
The mode ofonset ofa symptom:
a. Description ofevents coincident with onset.
b. Whether there have been similar episodes in the past.
c. Whether the onset was gradual or sudden.
d. The total duration ofthe symptom.
3
The location ofthe symptom (ifapplicable).The location should be
anatomically precise.
4
The character ofthe symptom (eg,dull,sharp,or burning pain).
5
The radiation ofthe symptom (ifapplicable).Radiation ofthe symp-
tom (the pattern of spread) is most often applicable to a patient’s
description ofpain or an abnormal sensation.
6
Precipitating or aggravating factors.
7
Relieving or ameliorating factors.
8
Past treatment or evaluation ofthe symptom:
a. When,where,and by whom?
b. What studies were performed in the past and what were the
results (ie,blood studies,x-rays,etc)?
c. Past diagnosis and treatment.
d. When inquiring about medications,be sure to include over-the-
counter and herbal remedies.
9
Course ofthe symptom (getting worse,getting better).
10
Effect ofthe symptom on normal daily activities.
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The Common
Symptom Guide
Notice
Medicine is an ever-changing science.As new research and clinical experi-
ence broaden our knowledge,changes in treatment and drug therapy are
required. The authors and the publisher of this work have checked with
sources believed to be reliable in their efforts to provide information that is
complete and generally in accord with the standards accepted at the time of
publication.However,in view ofthe possibility ofhuman error or changes
in medical sciences, neither the authors nor the publisher nor any other
party who has been involved in the preparation or publication ofthis work
warrants that the information contained herein is in every respect accurate
or complete,and they disclaim all responsiblity for any errors or omissions or
for the results obtained from use ofthe information contained in this work.
Readers are encouraged to confirm the information contained herein with
other sources.For example and in particular,readers are advised to check the
product information sheet included in the package ofeach drug they plan to
administer to be certain that the information contained in this book is accu-
rate and that changes have not been made in the recommended dose or in
the contraindications for administration.This recommendation is ofpartic-
ular importance in connection with new or infrequently used drugs.
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SIXTH EDITION
The Common
Symptom Guide
A Guide to the Evaluation of Common
Adult and Pediatric Symptoms
JOHN H. WASSON, MD
Professor ofCommunity and Family Medicine and Medicine
Herman O.West Professor ofGeriatrics
Dartmouth Medical School
Hanover,New Hampshire
B. TIMOTHY WALSH, MD
William and Joy Ruane Professor ofPsychiatry
College ofPhysicians and Surgeons
Columbia University
New York,New York
MARY C. LABRECQUE, ARNP/MSN
Instructor in Community and Family Medicine
Dartmouth Medical School
Hanover,New Hampshire
HAROLD C. SOX, JR., MD
Editor
Annals ofInternal Medicine
Philadelphia,Pennsylvania
ROBERT PANTELL, MD
Professor ofPediatrics
University ofCalifornia at San Francisco
San Francisco,California
ELIZABETH S. WASSON
Resident in Medicine
Tulane University Medical Center
New Orleans,Louisiana
New York Chicago San Francisco Lisbon London Madrid Mexico City
Milan New Delhi San Juan Seoul Singapore Sydney Toronto
Copyright © 2009, 2002, 1997, 1992, 1984, 1975 by The McGraw-Hill Companies, Inc. All
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database or retrieval system, without the prior written permission of the publisher.
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To Halstead Holman, MD
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Preface
Symptoms are common. During a month, 800 of 1000 persons report
symptoms and 300 ofthese visit a clinician.When patients with symp-
toms seek a clinician’s help, they expect an explanation. The Common
Symptom Guidedeals in depth with symptom evaluation so that the user
can provide an explanation.
Since its introduction over 30 years ago,The Common Symptom Guidehas
given clinicians in training—physicians, nurses, physicians’ assistants, and
nurse practitioners—a tool for evaluating patients in busy practice settings.It
provides a listing of pertinent questions,physical findings,and differential
diagnoses for more than 100 common adult and pediatric symptoms.
With increasing experience,students ofhealth care learn that the symp-
tom a patient describes may not be the only reason that medical attention
is sought.Clinicians who base their evaluation only on the symptom may
take needless diagnostic or therapeutic measures because they have failed to
identify how the complaint relates to the patient’s function.The Dartmouth
COOP Charts were designed to overcome this limitation.The charts are an
efficient, valid, and reliable way for identifying important limitations in
patient function.
The sixth edition of The Common Symptom Guideoffers an electronic
enhancement. www.howsyourhealth.org automatically links age-specific
symptom and function assessment with explanation.Users ofthe guide are
urged to refer their patients to this site whenever general “checkup”is indi-
cated.Patients receive information tailored to their needs and management
forms that summarize the concerns for their clinicians.
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Acknowledgments
We wish to express our gratitude to the nurses,medical students,nurse
practioners,physician’s assistants,and physicians whose comments
have been so valuable to us.
Partial support for the first and second edition work was provided by the
National Fund for Medical Education and by the Robert Wood Johnson
Foundation through the Stanford University Clinical Scholars Program.
The Dartmouth COOP Charts were developed and tested in clinical prac-
tice with the support of the Henry J. Kaiser Family and WT Grant
Foundation. This sixth edition includes a suggested link to www.hows
yourhealth.org. We are indebted to the John A. Hartford Foundation of
New York City and the Commonwealth Fund for research and development
ofthis Internet site.
Color Plates are between pages 278 and 279.Plates 1-9 refer to
Lump–Lymphadenopathy.Plates 10-15 refer to Skin Problems.
