It's what a patient feels that prompts them to seek your care. But they can't feel their adrenals stressed to exhaustion. They can't feel their left kidney underperforming by 10%. They can't feel the plaque build-up in their pulmonary artery.
How someone feels is a poor judge of their well being. You've explained that a million times--even though it's what prompts most to begin care.
They consult you for Problem A. But they have a more serious Problem B.
Problem is, you've just met them. You haven't established credibility. They're wary. Even a flight risk.
Do you tell them the truth? Or do you dance around the issue hoping for a better occasion to explain what's really going on?
Many withhold and wait. With two predictable outcomes: 1) a better time rarely appears, and 2) if it does, their overtures are often perceived as manipulative or financially motivated. Oops!