As a young person living with chronic pain, I entered a health care system that was built to find explanations to clinical problems. That is, of course, what medicine is supposed to do. Physicians are trained to identify patterns, order tests, interpret results, establish diagnoses, and develop treatment plans. When those pieces fit together, the process can feel almost reassuring. There is a problem; there is an explanation; and there is a plan. Chronic pain does not always offer that clarity.

For a young patient, that uncertainty can be particularly difficult. Youth carries its own assumptions. Young people are generally expected to be healthy. We are expected to recover. We are expected to be resilient. Persistent pain can therefore seem out of place before a clinician has even begun considering what might be causing it.

I began to understand that medicine was asking two different questions: “Are you in pain?” and “Can we explain your pain?” These two questions are not asking the same thing. The first is a report from the person experiencing the symptom. The second is a clinical problem that medicine is tasked with solving. Yet, when the second question does not have an immediate answer, it can become surprisingly easy for the first to become less credible. This is one of the most difficult lessons chronic pain has taught me.

Pain is subjective, but that does not mean it is unreal. Medicine necessarily depends on objective information, including laboratory values, imaging, physical examinations, diagnostic criteria, and other forms of measurable evidence. These tools are essential. But they can become limiting when we begin treating the absence of objective evidence as evidence that a patient’s experience is less legitimate. Young patients can be particularly vulnerable to this dynamic.

A young person describing persistent pain may encounter assumptions that the symptoms are temporary, stress-related, exaggerated, or something that can simply be managed in the absence of concrete biological pathology for such pain. For young women, those assumptions can intersect with longstanding patterns in which pain and other symptoms are interpreted through psychological, hormonal, or behavioral explanations before the patient’s own account is fully considered.

There is nothing inherently wrong with considering the above contributors to pain. Pain is complex, and the mind and body cannot be cleanly separated. The problem arises when “psychological” becomes synonymous with “imaginary,” or when uncertainty becomes a reason to stop listening.

My experience eventually changed the way I thought about medicine. I became less interested in whether a health care system could produce a perfect explanation for every symptom and more interested in what happens when it cannot. So, who gets to decide whether a patient’s experience is medically meaningful?

The answer is rarely just the patient and physician. A patient’s experience passes through a much larger system: the medical record, diagnostic criteria, treatment guidelines, insurance policies, institutional practices, and sometimes legal and regulatory structures. Each can determine what counts as sufficient evidence, what treatment is considered appropriate, and whose interpretation of a patient’s condition carries the most weight. That raises a difficult question: What happens when the person experiencing the symptom has the least authority over how that symptom is interpreted?

My own experience with chronic pain eventually led me beyond the role of patient. I became interested in health research, patient advocacy, disability, and the systems that shape medical decision-making. I began to see my experience not simply as an unfortunate chapter in my life, but as an education in how health care institutions work and where they can fail the people they are intended to serve.

That perspective has also made me more interested in the intersection of medicine and law. Both fields are, in different ways, concerned with evidence, credibility, responsibility, and decision-making under uncertainty. Both must determine what information is sufficiently reliable to justify action. But patients do not experience their bodies as legal arguments or clinical datasets. They experience them as lives.

A young patient may not be able to provide a physician with a definitive explanation for why she hurts. She may not have an imaging result that makes her symptoms immediately legible. She may not fit neatly into a diagnostic category. None of that means that her role in her own care should become smaller. In fact, uncertainty should make listening more important, not less.

This does not mean that physicians should accept every patient’s interpretation of their symptoms without question. Medicine requires skepticism. It requires differential diagnoses, evidence, and careful clinical judgment. But skepticism should be directed toward the unanswered clinical question, not toward the credibility of the person asking for help. There is an important difference between saying, “I don’t yet know why this is happening,” and saying, explicitly or implicitly, “Because I don’t know why this is happening, I am less certain that it is happening.”

Young patients deserve the former. Chronic pain taught me that medicine does not need to have every answer to provide meaningful care. Sometimes the most important clinical intervention is acknowledging uncertainty while continuing to investigate it.

The young patient sitting across from a physician may not have the vocabulary to explain what is happening in her body. She may not understand the medical system yet. She may struggle to advocate for herself. She may even begin to doubt her own experience after hearing that her symptoms do not make sense. But she is still the person living in that body.

Medicine does not have to choose between scientific rigor and believing patients. It can demand evidence while recognizing that patients are themselves a form of evidence, particularly when their experiences reveal gaps in what medicine currently knows.

My chronic pain did not teach me that physicians should always have the answer. It taught me that when they don’t, they should keep listening.

Vidya Surti is a patient advocate.