How Should Persistent Symptoms Not Fully Explained by Diagnosis Be Studied? A Protocol for Scope, Observational Language, and Dual-Track Safety
Some patients continue to experience symptoms and impaired daily function after receiving a diagnosis or completing multiple investigations. These experiences arise in different situations—including residual symptoms of established disease, an evolving differential diagnosis, functional syndromes, and changes after infection or treatment—and should not be collapsed into one cause or a new disorder. This protocol proposes a way to preserve those differences while observing features that diagnostic labels may miss: sequence of onset, symptoms that change together, daily context, loss of function, and response to treatment over time. Two paths remain active. One continues appropriate medical differential diagnosis and reassessment as symptoms, red flags, and trajectories change. The other records patient-important symptoms and function, treatment exposure, and harm without waiting for perfect diagnostic closure. Contemporary research and lived experience are read alongside East Asian primary texts, commentaries and cases, and Korean, Chinese, and Japanese clinical traditions without assuming that their concepts are equivalent. Whether Korean-medicine observations add value must be tested by asking if they improve reproducibility, prediction, or clinical decisions beyond diagnoses and standard measures alone. This is a research design, not a screening tool, treatment recommendation, or efficacy claim.