Should I be worried, Doc?

    27 September 2014

    I have a cartoon on my office wall at home that I look at every day when I am writing. It shows a GP standing beside the bed of a worried-looking patient. Next to him stand a smartly dressed consultant and a smiling chap in a Hawaiian shirt and shorts. The GP is saying to his patient, ‘I’ve taken the liberty of calling in a second opinion. One is a consultant. The other is an enthusiastic amateur.’

    What would the difference actually be between these two medically interested types? The main one would probably be that if the amateur was asked to list potentially dangerous symptoms about the patient he might get three or four and then start to run out, whereas the consultant would probably still be going strong for quite some time.

    The usual aches and pains, mild sore throat or generally feeling under par for a day or two that we all sometimes suffer are part of the general human condition and should never be treated as a medical conditions as such, but it is a fact that the more a doctor looks for signs of a serious illness, the more he or she will find. But most of these symptoms will not be indicative of any serious illness whatsoever.

    For more nervous people, though, symptoms of any kind send them into a panic that they have a serious illness. The internet exacerbates the problem, since googling symptoms often increases the anxiety.

    The phrase ‘Should I be worried, Doc?’ is one I often hear in my surgery, and so over the years I have compiled a list (far from comprehensive) of symptoms that doctor and patient ignore at their peril. The obvious one that everyone is aware of is chest pain. This is the big one to get out of the way first. Any discomfort that feels like someone sitting on or squeezing your chest should always be medically assessed — and quickly. It may also be accompanied by pain going down one or both arms, sweating, feeling sick or being short of breath. These symptoms may mean you are having a heart attack but a more usual explanation is simply that stomach acid is inflaming the gullet and giving almost identical symptoms. The message here, however, is a simple one — never ignore chest pain. Seek medical advice fast.

    My other ‘Top 10’ symptoms that should always involve getting medically checked out are listed below. Often such symptoms turn out to have no serious cause, but if you are suffering from one (or more) you won’t know this without having been seen by your doctor. Listen to your body — it might be trying to tell you something.

    Symptoms to be heeded



    Profound or prolonged tiredness — different to the usual low-level tiredness most of us experience — that cannot be explained by a lack of sleep should be investigated. Doctors call it ‘TATT’ (tired all the time). For the vast majority of patients this is due to lifestyle rather than a serious illness, but if it is unusual it should be checked out. Often the first thing your doctor will do is a simple blood test for diabetes, anaemia and an underactive thyroid.

    Weight loss

    Sudden or unexplained weight loss should always be investigated. Whereas weight gain is rarely a sign of anything sinister, unexpected weight loss can sometimes be the first sign of serious illness somewhere in the body.

    Trouble swallowing

    Simple acid reflux can cause this, but any difficulty in swallowing food — especially bread or meat — that develops over any length of time may not be due to a benign problem. If there is difficulty swallowing liquids, then a doctor should be consulted as soon as possible, especially if there is also a loss of appetite.

    Rectal bleeding

    Bleeding from the back passage should never be dismissed as being due to piles. Although haemorrhoids remain the commonest cause of such bleeding, never assume this is the case without getting it checked by your doctor. Even if you do have piles, bleeding may indicate another disease, such as bowel cancer.

    Change in bowel movements

    Any prolonged change that lasts for more than a fortnight or so should be assessed. For instance, this could be unexplained diarrhoea, a feeling that the bowels have not emptied properly in some way, or becoming constipated unexpectedly.

    Easy bruising

    If simple knocks or bumps cause severe bruising, then a blood test may be needed to check all is well. Although the skin and blood vessels become more fragile with age — and many elderly people bruise very easily as a result — if there is significant bruising for no obvious reason (and especially if the gums bleed too) then this should be investigated.

    Blood in the urine

    Known as haematuria, this is sometimes due to an infection but can be a sign of bladder growths. It does not matter if there is no pain with the bleeding; always go to your GP and have a urine sample checked.


    Everyone gets headaches at some time and the usual cause is tiredness, stress or poor posture. Headaches that persist after you take painkillers, or which are chronic, or which are associated with nausea, vomiting or blurred vision, or which wake you up, should never be ignored.

    Vaginal bleeding

    Any woman who has unusual bleeding after the menopause, or has bleeding after intercourse, should be examined. There are many possible benign causes for this problem but also a number of worrying ones, and if in doubt always get checked out.


    Yellow discolouration of the eyes and skin is never normal and must be assessed. The cause can be relatively innocuous or it can be serious, including viral infections of the liver, cirrhosis and tumours.