Healthlines

To take a history and get clues to what ails our patients, certain basic questions are important to all physicians...presence or absence of the symptoms or pain, it's location, does it go anywhere else, what makes it better or worse, is it associated with anything...food, time of day, place, any behavior and are there any other symptoms...

One of the problems working as a physician and seeing patients is that most patients unfortunately have very little clue about the answers to these questions...

WHY IS THIS IMPORTANT???

Because medicine is a very complex detection game...based solely on our history taking, we have to make a best guess as to what is going on in your body and then follow our deductive reasoning with confirmatory tests...

Just like at a crime scene, it is easy to be misled by inadequate information, conflicting storylines and objects that are out of place...Studies have been done which show that most physicians within 10-15mins of talking to a patient, have a good best guess as to what might be wrong which is 85% right, after the physical exam, that percentage increase to >90%, following this, they order tests to basically confirm their suspicions or in the 10% of cases where they are really not sure, to guide them in their suspicions and rule in or rule out certain diseases...

Because most of the diagnosis is based on the history, you can see how important it is for the patient to give a very detailed history as to what is going on. Any yet, for most people, this is where the medical encounter goes awry...

Medicine being what it is today, doctor are limited by market forces to how much face to face time they can have with patients...it's not a great situation for patients or doctors..however, these are the times...we just cannot afford to spend much more time with patients. We have to do much with little time so what's a patient to do to make sure that that time counts when they do get face to face...Well, given for the fact that most diagnosis can be made in just about that time, the simple thing to do is to MAKE SURE YOU KNOW YOUR HISTORY of illness COLD...

1. KNOW YOUR SYMPTOMS AND THE TIMELINE of occurrence
2. BE VERY CLEAR ON WHAT YOU WANT TO ACHIEVE IN THAT VISIT...
3. MAKE A LIST OF WHATS IMPORTANT and STICK with it. A common mistake patients make is to come with a shopping list of things to talk about...after spending 10 minutes talking about the small stuff, they wait till the last 2 minutes to tell you the BIG TICKET ITEMS...that is shortchanging themselves! There is NO TIME to deal with the major things and do justice to them in 2 minutes....given doctor's time constraints, time is limited and other patients are waiting so most doctors schedule a return visit to discuss the new issues...and patients get VERY IRATE.

Unfortunately, TIME IS AT A PREMIUM...as a patient, if you want to get what you want THAT DAY, the best defense - and a good offense -- is to come prepared to the medical visit with the most important items (2 or 3) and try to get through those things in that visit...anything else can be deferred to another time when it can be combined with other issues.

In the same way that patients shortchange themselves by waiting till the last minute to discuss big issues, the other mistake often seen in practice is patients who bring VERY LONG LAUNDRY LISTS OF ITEMS they want to cover in ONE visit...

Time yoursef. How much conversation can you get in in 15 minutes...if you were talking to a friend, a colleague and having a two way conversation, how much meaningful information can you squeeze into that timeframe...

Once again, remember, physicians are medical detectives...as a patient, you give clues and they try to figure out based on the clues what is going on...Imagine going to a complex crime scene and in 15 minutes trying to decide whodunit???? or on a more mundane scale, imagine taking your car to the mechanic and expecting that in 15 minutes, he would have your car fixed and running as good as new....how long does a plumber take to fix a leaking faucet??? That being the case, patients who try to get the leaky sink, the blocked toilet, the broken gutter, the weird noise in the car, the wobble in the steering and the grinding that the door makes whenever it opens in 15minutes, get NO SATISFACTION....sorry guys, it is just not possible to do a good job with a patient who comes in with a list of 20 things they want fixed in 15 minutes of a back and forth conversation, interspersed with pleasantries and remember whens!

So be a savvy patient.
Save the small talk for the hello's and goodbyes,
Get to the point QUICKLY and DIRECTLY
Know the facts about your symptoms and state them without a lot of embellishments...
Equip your doctor with all the information he or she needs to best help you in that visit.
Generally this should get you the best bang for your healthcare buck and save many repeat visits to try to get to the bottom of what's really wrong with you.

And have patience...SOMETIMES, the crime scene (aka your disease) isn't quite as simple as it seems and it takes some digging up of new clues, following up of leads (testing and testing and MORE TESTING) to figure it out. Sometimes, it takes specialists, a team and much expertise...but you are our best lead in figuring out the dastardly problem plaguing you...

THE POWER is in the patients ability to give the BEST HISTORY possible so we can figure things out quickly. So feel free to write down your symptoms...

One of my patients actually had a history of her symptoms that went back 1 YEAR..she then took pictures of her rashes on her digital camera...thank GOD for that...her disease was so rare that only by tying together all those various strange and seemingly unrelated events was I able to diagnose her disease in minutes...with the AID of her beautifully illustrated history, Before that visit, she had seen several doctors - 1 symptom at a time - and the diagnosis could not be made. Fortunately for her AND me, as luck would have it, she finally came to me with an EXTENSIVE written HISTORY + PICTURES and I was able to diagnose her condition, BECAUSE of the completeness of her history. Today, she is on treatment. Had she come to me with bits and pieces, I too would have been stumped and unable to help...That is the importance of the history patients give.

Remember, most of the medical detective work is done during the initial interview so go in there prepared.