Essential
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4 min
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February 6, 2026
AbdulKhaliq Akinwunmi
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For thirty years, a sickle cell patient managed their pain. They called in sick when the crises hit, learned which positions made the suffering bearable, and tried everything; diets, supplements, stress management techniques. Anything to keep functioning.
Then a doctor asked one question nobody had asked before: "has anyone screened you for sickle cell?" A month later, after hydration, pain control, and daily hydroxyurea with folic acid, they were back to normal life. Thirty years of suffering, solved in weeks. Because someone finally asked.
This is how symptoms float in silence
Most people think of diagnosis in a linear line; you get sick, you see a doctor, they run tests, they find the problem.
Here's how it actually goes.
You feel off and you rationalise it. After all, you've always been tired. This is just how your body works. You mention the fatigue during your annual physical, and your doctor runs standard bloodwork. Everything comes back normal. "Probably stress," he says. "Try to sleep more."
Six months later, the joint pain starts. You see a rheumatologist. He focuses on the joints, not the fatigue. Prescribes anti-inflammatories. They help, slightly. Another year passes. Now you have rashes, and need to see a dermatologist who'll most likely prescribe creams.
Three specialists ran three sets of tests and delivered three diagnoses that treated symptoms. Nobody had the full picture because nobody asked for it. Yet, that silence in between appointments is where people get lost and there are three forces creating it:
Time pressure. The average doctor visit is fifteen minutes. In that window, they need to hear your complaint, examine you, document everything, and decide on next steps. There's little to no room for "tell me about every symptom you've ever had."
Symptom overlap. Fatigue shows up in everything. So does pain. So do mood changes. When every condition looks similar on the surface, doctors default to the most common explanation. The rare ones stay hidden.
Patient normalisation. You stop asking yourself. "I've always been tired." You learn to live with it. Then you downplay it to doctors because you've downplayed it to yourself for years. The result is conditions that should be caught early — sickle cell, autoimmune disorders, hormonal imbalances, nutritional deficiencies — slipping through for years. Sometimes this lasts for decades.
Questions that cut through
There's a pattern in the patients who get diagnosed fastest. It's not that they have the most obvious symptoms. Rather, they ask better questions.
For unexplained chronic symptoms:
"What else could cause this cluster?" - One patient had been treated for "chronic fatigue syndrome" for four years. Her new doctor didn't accept the previous diagnosis, so he asked what else could cause her specific combination of fatigue, joint pain that migrated, and photosensitivity. He then ordered an ANA test, which came back positive. Four years of suffering, solved in one appointment because he asked "what else?"
"Is there a screening test even without obvious risk factors?" - Sickle cell was the most common condition we managed last year. However, if nobody screens because you "don't look like" the typical patient, you stay undiagnosed.
"Should we rule out [X] before treating symptoms?" - Another patient had been diagnosed with chronic migraines and put on three different preventive medications. None worked because he didn't have migraines. He had a cerebrospinal fluid leak. One specialist asked if they'd ever imaged his spine. They hadn't. A simple patch procedure fixed what years of migraine drugs couldn't. This is what happens when you treat symptoms without knowing the cause: you're silencing a fire alarm instead of putting out the fire.
For family history gaps:
"My [relative] had [symptom], should I be screened?" - Be specific. Not just "heart disease runs in my family," but "my uncle had joint pain that was never explained, my cousin has lupus, and my grandmother was always tired."
"Are there genetic conditions common in [my background]?" - This is especially important for underserved regions, like Nigeria. Medical literature skews toward studied populations, which means standard screening might miss things that are actually common here.
For "normal" test results that don't match how you feel:
"If this is normal, what explains these symptoms?" - A normal test means that specific test found nothing. It doesn't mean nothing is wrong.
"Is there a different test or specialist who might see something this didn't catch?" - Sometimes it's a rheumatologist. Sometimes a genetic specialist. This question opens that door.
Building a pharmacy that cares
At Famasi, we started seeing the pattern upon launch. Patients arriving with years of medical history, dozens of tried solutions, still without answers. They weren't failing to advocate for themselves, but they were asking questions in a system designed for speed, not depth. So we started doing the opposite from day 0:
Personalised reminders that don't assume. We send prompts based on symptoms, history, and background, not just standard checklists.
Symptom tracking that finds patterns. Fatigue alone is vague. Fatigue plus joint pain plus cold sensitivity points somewhere specific. We connect dots that 15-minute appointments miss.
Care Specialists who stay with you. Healthcare fragments across your doctor, specialist, lab, back to your doctor. Nobody really owns the full picture. We're building a layer that does — a system that remembers what the rheumatologist said and asks whether the endocrinologist's theory fits with it. But we're not replacing your doctors, which is why we don't prescribe. Rather, we're catching what falls through the cracks of a fragmented system. It's still early. But the people who find us after years of searching? They're finally able to ask better questions because we give them more than enough room to.
Your appointment checklist
Until the system changes more broadly:
Bring a timeline, not just a complaint. Don't say "I've been tired." Say "the fatigue started in March, got worse in June, and now I can't get through a workday without napping." Patterns matter because they show progression and connections that isolated complaints hide.
Mention family history even if they don't ask. Be specific. "My uncle had unexplained joint pain. My cousin has lupus. My grandmother was always tired."
Ask about screening, not just treatment. When you ask "should we test for anything before treating this?" you shift the conversation from managing symptoms to finding causes.
Push back when the answer doesn't fit. If you're told it's stress but your stress levels haven't changed, say so. If you're told it's aging but you're thirty-two, question it. You're not being difficult. You're being accurate, and accuracy is what gets you to the right diagnosis.
One question can cost a lot
Back to that sickle cell patient. Thirty years. How many missed workdays? How many relationships strained by unpredictable pain? How many nights wondering if it was all in their head?
It took one question and one blood test to get a diagnosis, and then one month of proper treatment to get their life back. The cost of not asking is measured in years of suffering, missed opportunities, and treatments that never worked. On the other hand, the power of asking is measured in weeks to recovery. Often, the gap between symptoms and diagnosis isn't medical, but conversational. Ask that question because it can change everything.
Have a story about getting diagnosed late, or finally getting answers after asking the right question? Tell us about it at stories@famasi.africa.
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