How to Talk to Patients About "Normal" Tests and Ongoing Symptoms

johnhayesjr1
Oct 10
2 min read

One of the most frustrating situations for both physician and patient is this: “All your tests are normal… but I still can’t feel my feet.”

Peripheral neuropathy, especially in its early or small fiber form, doesn’t always show up on labs, imaging, or EMG. And when patients are told everything is “normal,” they start to doubt themselves, feel dismissed, or assume nothing can be done. As an independent physician, this is your moment to offer what many of these patients have never had: validation and a plan.

Why “Normal” Doesn’t Mean “Nothing’s Wrong”

Standard testing often misses:

Small fiber nerve damage (not visible on EMG)
Nutrient deficiencies within “normal” ranges but functionally low
Subclinical inflammation or metabolic stress
Early neuropathic changes that aren’t yet measurable

Patients may have:

Burning, tingling, or zapping sensations
Temperature sensitivity
Vague numbness that comes and goes
Normal strength and reflexes but clear sensory dysfunction

They’re not making it up. Their nerves are misfiring and you can explain why.

How to Communicate Effectively

Reframe the Conversation:

“Normal tests mean we’ve ruled out the dangerous causes. Now let’s find the correct one.”
“Your symptoms are real. Not everything shows up on a scan.”
“We’re going to look at your case functionally, not just diagnostically.”

Educate Through Empathy:

Use diagrams to explain nerve fiber types
Share how small fiber neuropathy works—even when EMGs are normal
Review lab markers for B vitamins, insulin resistance, or inflammation

Patients want to understand their symptoms. When they feel heard and supported, adherence improves—and so does trust.

📞 Want to Become the Physician Who Brings Clarity When Others Can’t?

Book a Strategy Session with John Hayes Jr., MD and learn what protocols help independent physicians diagnose and explain neuropathy in real-world terms building deeper relationships and better outcomes.