When normal tests end care too early

Kees van Boven

doi:10.3399/bjgp26X744381

Published eLetters

eLetter submission guidelines

Submit a Response to This Article

Compose eLetter

Title *

Author Information

Contributors

First Name and Middle Initial *

First or given name, e.g. 'Peter'.

Last Name *

Your last, or family, name, e.g. 'MacMoody'.

Email Address *

Your email address, e.g. higgs-boson{at}gmail.com. PLEASE NOTE: your email address will be published.

Occupation *

Your role and/or occupation, e.g. 'Orthopedic Surgeon'.

Affiliation *

Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.

Statement of Competing Interests

Competing interests? *

Yes

Please describe the competing interests

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

Jump to comment:

When normal tests end care too early
David Bossano

Published on: 17 March 2026

Published on: (17 March 2026)
Page navigation anchor for When normal tests end care too early
When normal tests end care too early
David Bossano, GP, St Leonards Practice
Kees van Boven makes good points that we (medical professionals) should accept the experiential reality of patients’ symptoms and offer professional compassion for the suffering these symptoms represent.

The benefits of a normal clinical assessment and diagnostic work-up are that we can be reasonably confident and reasonably reassuring that we have not identified “serious” (in the sense of life-limiting) and/or treatable conditions. Nevertheless, the patient’s suffering still exists and may persist. Caring (professional compassion) can continue, but we should consider how far this can or should reasonably go.

If there are no evidence-based interventions for a distressing symptom, there is a risk of offering interventions without known benefit, out of a spirit of wanting to help, perhaps, but ultimately risking harm, e.g., through adverse effects, drug dependence and medicalisation.
The opportunity cost and impact on the practitioner should also be considered. The doctor can offer themself and their care in a therapeutic way, but providing this for some patients will limit it for others and providing a supportive relationship in the absence of diagnostic assessment or medical intervention may create different pressures and strains on a practitioner than working primarily as a diagnostician and prescriber. Support workers and therapists tend to have access to supervision and debriefing, which may be lacking for GPs, other t...
Show More

Kees van Boven makes good points that we (medical professionals) should accept the experiential reality of patients’ symptoms and offer professional compassion for the suffering these symptoms represent.

The benefits of a normal clinical assessment and diagnostic work-up are that we can be reasonably confident and reasonably reassuring that we have not identified “serious” (in the sense of life-limiting) and/or treatable conditions. Nevertheless, the patient’s suffering still exists and may persist. Caring (professional compassion) can continue, but we should consider how far this can or should reasonably go.

If there are no evidence-based interventions for a distressing symptom, there is a risk of offering interventions without known benefit, out of a spirit of wanting to help, perhaps, but ultimately risking harm, e.g., through adverse effects, drug dependence and medicalisation.
The opportunity cost and impact on the practitioner should also be considered. The doctor can offer themself and their care in a therapeutic way, but providing this for some patients will limit it for others and providing a supportive relationship in the absence of diagnostic assessment or medical intervention may create different pressures and strains on a practitioner than working primarily as a diagnostician and prescriber. Support workers and therapists tend to have access to supervision and debriefing, which may be lacking for GPs, other than informally (or via e.g. a Balint Group).

The challenge is that almost all human distress can be framed medically or have medical impacts. Tiredness, sadness and pain (for example) have many causes, and not all of these can be solved or relieved medically.

Maybe there are limits to what medicine and medics can help with, and maybe we should try to make the boundaries of our professional competence clearer, without losing our professional compassion?

Show Less

Competing Interests: None declared.