Why Do Some Clinicians Continue to Demand Objective Measures in the Face of a Subjective Sensation? The Curious Case of Chronic Breathlessness

Chronic symptoms such as pain or breathlessness have a lot in common. Decades ago, some clinicians would refuse to accept that a person had pain if there wasn’t some objective evidence on a plain X-ray. The advent of increasingly sophisticated imaging with finer resolution had many clinicians keen to find an anatomic correlate to support someone’s complaint of pain. Ever more sophisticated imaging has shown that this assumed correlation between symptom and pathology is often not present. For many people there is still nothing to see on scans that explains their symptoms (and for others unexpected abnormal radiologic findings are associated with no pain). We have learned that the lack of findings does not mean that a person is not experiencing pain...