Diagnosis or Symbolic Assumption

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To borrow from Robert Sapolsky in Behave: “Has medicine, in certain instances, yielded to symbolic reasoning rather than adhering strictly to scientific rigor?”

I’ve come to a troubling realization: not every diagnosis faithfully corresponds to the underlying illness.

Consider a familiar scenario.

An adult patient presents with a cough and difficulty breathing. The doctor asks whether they smoke. “No.”
“Are you exposed to secondhand smoke?” Again, no.

At this point, one might expect a careful examination. Instead, a label is applied—sometimes forced into place, as if with a shoehorn and a strip of duct tape. The doctor prescribes an inhaler, assuming COPD. The treatment fails—not only because the diagnosis is incorrect, but because the patient experiences side effects such as trembling hands and heightened nervousness.

At the next visit, rather than reassessing the initial assumption, a different medication is prescribed. By the third appointment, still without improvement, the patient asks for proper testing and begins to suggest alternative explanations.

The response? Not curiosity, but dismissal. In a ten-minute consultation, the patient is recast—not as someone seeking answers, but as “aggressive” or “internet-informed.”

What began as a medical problem quietly becomes a social one: preserving the initial label takes precedence over pursuing accuracy.

One of many possible examples illustrates this issue: 
An adult patient presenting with a cough and breathing difficulties enters a doctor’s office and is asked whether they smoke. “No,” the patient replies. The doctor then asks, “Are you exposed to secondhand smoke?” Once again, the answer is no.

Instead of conducting a thorough examination, a symbolic label is assigned. The doctor prescribes medication, assuming a bronchial infection. The treatment fails because the diagnosis is incorrect.

At the next appointment, rather than exploring alternative causes, the same doctor prescribes a different medication. By the third visit, with no improvement, the patient insists on proper testing to determine the true cause and begins to suggest possible alternative explanations.

Instead of being taken seriously, the brief ten-minute appointment ends with the patient being labeled as “aggressive” or dismissed as “internet-informed.”

This scenario reflects a broader issue: breathing problems and a cough are symptoms, not diagnoses. They can arise from a wide range of conditions—some mild, others potentially life-threatening. Medically speaking, dozens to over a hundred different illnesses may present with these symptoms. Understanding this complexity requires moving beyond assumptions and considering the full spectrum of possible causes.

These causes can generally be grouped into several categories:

Respiratory conditions such as asthma, bronchitis, pneumonia, chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, and lung cancer.

Cardiovascular conditions including heart failure or fluid accumulation in the lungs (pulmonary edema), which can mimic respiratory illness.

Infectious diseases such as viral infections (including influenza or COVID-19), bacterial infections, or less common conditions like tuberculosis.

Environmental and allergic factors, including exposure to pollutants, dust, mold, or chemical irritants.

Other systemic or less obvious causes such as acid reflux (GERD), post-nasal drip, anxiety-related breathing issues, or side effects from certain medications.

Because these categories overlap in presentation, symptoms can vary widely. A careful and comprehensive evaluation is essential.

Possible Related Symptoms

In addition to cough and breathing difficulty, patients may experience:

  • Shortness of breath during exertion or at rest
  • Chest tightness or chest pain
  • Wheezing or whistling sounds when breathing
  • Persistent or worsening cough (dry or productive)
  • Production of mucus (clear, yellow, green, or bloody)
  • Fatigue or reduced physical endurance
  • Fever or chills
  • Night sweats
  • Unintentional weight loss
  • Hoarseness or changes in voice
  • Rapid or irregular heartbeat
  • Swelling in the legs or ankles
  • Dizziness or lightheadedness
  • Frequent throat clearing or a sensation of mucus in the throat
  • Heartburn or acid taste in the mouth
  • Anxiety or a feeling of air hunger

The overlap of these symptoms across many conditions highlights the danger of premature conclusions. Without appropriate testing—such as imaging, lung function tests, or laboratory work—treatment may be based more on assumption than evidence.

A diagnosis should not be a symbolic shortcut. It should be the result of careful listening, thorough investigation, and a willingness to reconsider initial impressions. Only then can treatment move from guesswork to precision.

 

© 2000-2030 Sieglinde W. Alexander. All writings by Sieglinde W. Alexander have a fife year copy right. Library of Congress Card Number: LCN 00-192742 ISBN: 0-9703195-0-9    

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