I thought I would try and explain how important it is to try and help your GP to help you and what information you need to tell them.  The main way is to make sure that the GP 100% understands exactly what is concerning you.

As a medical student when assessing a patient, you are told to cover the following:

  • Symptoms
  • Signs
  • Special investigations 

What do symptoms mean in medical terms?

"A symptom is a manifestation of disease apparent to the patient himself, while a sign is a manifestation of disease that the physician perceives"

A sign is something the GP can see – a rash, a reading (i.e. blood pressure, ECG, scan), a temperature. 

A symptom is something the patient describes and needs to be interpreted by the GP – a type of pain, a sensation (i.e., burning, tingling, sore). 

I was also taught that 90% of the diagnosis (or list of possible diagnoses) was made just on the history and the main point of the history is to properly explore the symptoms. You then use signs and special investigations to confirm the diagnosis.

If you take pain, it is a good example of what the GP needs to know. It is not good enough just to say you have a pain, doctors are interested in all its characteristics. It is a good idea to think of the following points: 

  • location - exactly where it is.
  • radiation - some pains radiate for example main pain is around tummy button but also goes through to the back, or heart pain in chest but down the arm too.
  • mode of onset - sudden onset or gradual build up etc.
  • character - burning, stabbing etc.
  • temporal pattern - worse morning after meals etc.
  • exacerbating (make it worse) and relieving (makes it better) factors - relieved by being still or moving around, standing up, bending forward etc.
  • intensity - usually, 1-10.

Think about the “words” you are using.

If you google indigestion, you will get a lot of slightly different definitions from various sites. I looked at the NHS, Wikipedia, Mayo clinic. The doctor really needs to get a complete understanding of what your symptoms are. I have had people who used “indigestion” when they had difficulty swallowing or even diarrhoea.

Patients are sometimes difficult to engage in the right discussion and keep mentioning a diagnosis not their symptoms. A good example is hiatus hernia. Saying your hiatus hernia is playing up is not enough information, you need to explain exactly what you are experiencing.


Being examined is important but in most reflux and Barrett’s cases the patient may not show any obvious signs. Over the years I found a few signs, for instance the odd person who was anaemic or looked ill with weight loss.

Special investigations

  • Bloods
  • H Pylori test
  • The Cytosponge
  • Endoscopy
  • CT scan

I also want to discuss expert patients.

GPs know a little about a lot.

Consultants know a lot about a little.

Sometimes Consultants know almost nothing outside their core areas of interest.

Sometimes patients are better informed than both GPs and some specialists.

It is normal and good for a patient to take an interest in their own medical problems. With access to good resources and an interest in keeping up to date, they can have a far greater knowledge of their condition and be more up to date with developments.

Good examples would be the information patients might get from support groups / forums or by taking the time to read the new NICE guidelines which are readily available. 

As is true of all of us, expert patients can be wrong.  When working I used to embrace expert patients and never minded being challenged but that may not always be the case and it is best to work with your doctors to get the best outcome.

I hope this helps to get the most out of the NHS.