the best of circumstances, and the worst

 

 

 

Under the best of circumstances, it can be difficult for a health care provider to obtain a thorough and accurate medical history from a patient. Whereas the provider wants to hear about the onset, timing, severity, and nature of his symptoms, the patient may be focused on the fact that he had to miss work to keep his appointment, or that he can’t afford whatever tests or medications he may need. He may be ashamed to admit that he fell because he’d been drinking, or that he was coughing because he smokes, or that his sugar is high because he ran out of pills and can’t afford to refill his prescription. Or, he might simply have forgotten the details—for example, when his headaches first started, or how often he gets them, or what sets them off. All of which makes it hard to arrive at an accurate diagnosis.

 

“Diagnosis:

It is every doctor’s measure

of his own abilities;

it is the most important ingredient

in his professional self-image.”

~Dr. Sherwin Nuland~

 

And then there’s this:

 

We all have a friend or relative who can only be described as talkative. You know the kind-- mired in detail, obsessed with accuracy, insistent. A conversation with this person might go like this:

 

     Doc: So, when did the headache start?

 

     Pt.: It started last Tuesday. I remember because I had breakfast with my friend Barbara, and it started when I was driving home. No, wait. Maybe not. Maybe it was later that day, when I was in the grocery store. Or…did I go to the store on Wednesday? (pause) I don’t remember, but when I got home, I realized I didn’t have any Tylenol, so I took two Advil for it. Or…was it Aleve?

 

And so it goes, on and on and on in painstaking but inconsequential detail. And you only have fifteen minutes to coax the whole story out of this patient…

 

“Our lives begin to end

The day we become silent

About things that matter.”

~Martin Luther King, Jr.~

 

Or, you might meet up with this patient:

 

     Doc: I understand you’ve been experiencing some headaches.

 

     Pt.: Yup.

 

     Doc: When did they start?

 

     Pt.: A while back.

 

     Doc: Weeks ago? Months?

 

     Pt.: I guess.

 

You can’t pull a meaningful answer out of him if you kneel down and plead for it.

 

“I have learned now that,

while those who speak about

one’s miseries usually hurt,

those who keep silence hurt more.”

~CS Lewis~

 

In the first case, you wish you could shut the flood gates long enough to pull a few pertinent facts out of the overflow. In the other, you want to open the gates and net a few relevant answers before you move on.

 

The medical history challenges both of us, patients and providers alike. We’re in this together, and whether we are doing the speaking, or the listening, the correct diagnosis is our goal.

 

“Listen to your patient.

He is telling you the diagnosis.”

~Sir William Osler~

jan