Medical sign


A medical sign is an objective indication of a disease, injury, or abnormal physiological state that may be detected during the physical examination of a patient. These signs can be detectable by anyone, e.g. the temperature or blood pressure of the patient, skin that is redder than usual, or a bruise; others may have no meaning to the patient or may even go completely unnoticed. Medical signs assist a healthcare provider to reach an accurate diagnosis.
A symptom is something, such as pain or dizziness, experienced by the patient. Signs and symptoms are not mutually exclusive. In other words, many symptoms such as feeling hot, are associated with a medical sign such as a thermometer reading showing an above average body temperature.
Symptoms and signs are often nonspecific, but certain combinations can be suggestive of certain diagnoses, helping to narrow down what may be wrong. In other cases they are specific even to the point of being pathognomonic.
Examples of signs include elevated blood pressure, clubbing of the ends of fingers as a sign of lung disease, staggering gait, and arcus senilis of the eyes.
In medicine, a sign is distinguished from an indication; a specific reason for using a treatment.

Semiotics

Semiotics is derived from the Greek adjective σημειωτικός "to do with signs".
In English the art of interpreting clinical signs was originally called semiotics, a term now used for the study of sign communication in general. Semiotics, then written semeiotics, was first used in English in 1670 by Henry Stubbe, to denote the branch of medical science relating to the interpretation of signs:

Signs versus symptoms

Signs are different from "symptoms"—those subjective experiences, such as fatigue or headache—that patients might report to their physician.
For convenience, signs are commonly distinguished from symptoms as follows: Both are something abnormal, relevant to a potential medical condition, but a symptom is experienced and reported by the patient, while a sign is discovered by the physician during examination or by a clinical scientist by means of an in vivo examination of the patient.
A slightly different definition views signs as any indication of a medical condition that can be objectively observed, whereas a symptom is a manifestation of a condition experienced by the patient. A doctor may discover the sign of high blood pressure in a patient who does not report any symptoms associated with hypertension, and who does not realize they have a potentially harmful condition. There is some overlap between signs and symptoms—certain things may qualify as both a sign and a symptom, such as a bloody nose.
Lester S. King, author of Medical Thinking, argues that an "essential feature" of a sign is that there is both a sign and a "thing signified". And, because "the essence of a sign is to convey information", it can only be a sign, properly speaking, if it has meaning. Therefore, "a sign ceases to be a sign when you cannot read it". A person, who has and exercises the knowledge required to understand the significance or indication or meaning of the sign, is necessary for something to be a complete sign. A physical phenomenon that is not actually interpreted as a sign pointing to something else is, in medicine, merely a symptom. Thus, King rejects "these present-day views , however widely accepted, as quite faulty, at variance not only with ordinary usage but with the entire history of medicine."
" symptom is a phenomenon, caused by an illness and observable directly in experience. We may speak of it as a manifestation of illness. When the observer reflects on that phenomenon and uses it as a base for further inferences, then that symptom is transformed into a sign. As a sign it points beyond itself—perhaps to the present illness, or to the past or to the future. That to which a sign points is part of its meaning, which may be rich and complex, or scanty, or any gradation in between. In medicine, then, a sign is thus a phenomenon from which we may get a message, a message that tells us something about the patient or the disease. A phenomenon or observation that does not convey a message is not a sign. The distinction between signs and symptom rests on the meaning, and this is not perceived but inferred."

Types

Medical signs may be classified by the type of inference that may be made from their presence, for example:
" appearance may be described thus: the nose sharp, the eyes sunken, the temples fallen in, the ears cold and drawn in and their lobes distorted, the skin of the face hard, stretched and dry, and the colour of the face pale or dusky.… and if there is no improvement within , it must be realized that this sign portends death."

"Symptoms become signs when they permit inference. Ordinarily, one single symptom by itself—such as pain or swelling, or discoloration, or bloody discharge—would not permit any specific inference, but when symptoms occur in clusters and form a pattern, then the aggregate might point to a particular disease. The pathognomonic sign, however, does not need any other manifestation to lead the physician to the correct diagnosis. It constitutes a one-to-one relationship—the sign and the disease are uniquely related. The pathognomonic sign was the "clincher", the datum that established the diagnosis unequivocally."

Development of signs detectable by physicians

Prior to the nineteenth century there was little difference in the powers of observation between physician and patient. Most medical practice was conducted as a co-operative interaction between the physician and patient; this was gradually replaced by a "monolithic consensus of opinion imposed from within the community of medical investigators". Whilst each noticed much the same things, the physician had a more informed interpretation of those things: "the physicians knew what the findings meant and the layman did not".

Advances in the 19th century

Input from the patient was gradually reduced from the medical interaction due to significant technological advances such as:
The introduction of the techniques of percussion and auscultation into medical practice altered the relationship between physician and patient in a significant way, specifically because these techniques relied almost entirely upon the physician listening to the sounds of the patient's body.
Not only did this development reduce the patient's capacity to observe and contribute to the process of diagnosis, it also meant that the patient was often instructed to stop talking, and remain silent.
As these changes took place in medical practice, it was increasingly necessary to uniquely identify data that were accessible only to the physician, and to be able to differentiate those observations from others that were also available to the patient, and it just seemed natural to use "signs" for the class of physician-specific data, and "symptoms" for the class of observations available to the patient.
King proposes a more advanced notion; namely, that a sign is something that has meaning, regardless of whether it is observed by the physician or reported by the patient:

As tests

In some senses, the process of diagnosis is always a matter of assessing the likelihood that a given condition is present in the patient. In a patient who presents with haemoptysis, the haemoptysis is very much more likely to be caused by respiratory disease than by the patient having broken their toe. Each question in the history taking allows the medical practitioner to narrow down their view of the cause of the symptom, testing and building up their hypotheses as they go along.
Examination, which is essentially looking for clinical signs, allows the medical practitioner to see if there is evidence in the patient's body to support their hypotheses about the disease that might be present.
A patient who has given a good story to support a diagnosis of tuberculosis might be found, on examination, to show signs that lead the practitioner away from that diagnosis and more towards sarcoidosis, for example. Examination for signs tests the practitioner's hypotheses, and each time a sign is found that supports a given diagnosis, that diagnosis becomes more likely.
Special tests also allow a hypothesis to be tested. These special tests are also said to show signs in a clinical sense. Again, a test can be considered pathognonomic for a given disease, but in that case the test is generally said to be "diagnostic" of that disease rather than pathognonomic. An example would be a history of a fall from a height, followed by a lot of pain in the leg. The signs are only very strongly suggestive of a fracture; it might not actually be broken, and even if it is, the particular kind of fracture and its degree of dislocation need to be known, so the practitioner orders an x-ray—and, for example, if the x-ray were to show a fractured tibia, the film would be diagnostic of the fracture.

Examples of signs