The Art of History

Every time you go to the doctor, he or she will be taking a medical history.  Only sometimes it doesn’t look like they’re doing anything but sitting there listening to you.  In reality, they are executing a strict protocol, manipulating you for information by asking you leading questions and occasionally allowing you to babble.  Sometimes you’ll flippantly mention something that seems incidental to you, but has just cemented your entire presentation in the eyes of the doctor.  Since you are completely unaware of the protocol and the flow of questioning, the doctor has to outmaneuver you to remain on track.

Why am I going on about doctors and medical histories?

For the past 6 (and possibly even more) weeks, we’ve been learning how to take a medical history in our Doctor & Patient sessions.  Apparently something like 90% of a diagnosis is made off the medical history alone, so it’s no wonder that this exercise will continue to be drilled into us for many more weeks to come.

In our sessions, we are divided into ‘doctors’ and ‘patients’, and the ‘doctors’ prepare themselves for questioning while the ‘patients’ are given a sheet of responses to give.  The ‘doctors’ introduce themselves, and begin questioning the ‘patients’ as though they had come to see them for the first time.  Of course there’s a bit of silliness involved: “Do you use any illicit or recreational drugs” to which the reply will always be something in the vein of “No doctor, just some meth with my grandkids every now and then.”

After the questioning is finished, we must present our patient to the class, and this can sometimes be a tedious process as the class shares three cases and ‘oh – haven’t we heard this one already?’  After the presentation (which you rocked out), the only real doctor in the room will nod and say: “And what was his occupation?”

You stare blankly and of course that immediately tells everyone that you don’t know, because you didn’t ask.  You admit this to the group and think to yourself: “thank god I didn’t forget to ask about allergies or something,” when the real doctor says: “your patient works in a nuclear power plant.”

Shit.  Fuck.  Of course, he couldn’t have been a bricklayer.

Thankfully this is a theoretical session and I’m supposed to get it wrong (though getting it right sometimes might be nice), but here’s what we look for when questioning a patient, so you can give us newbies a bit of a hand…

The Presenting Complaint
This is the thing that made you say: “Bloody hell, looks like I’ll have to go to the doctor’s”.  It could be a persistent cough, a lump in your armpit or the fact that you haven’t had a period in 11 months and you always seem hot.

The History of the Presenting Complaint
This is supposed to be a chronological explanation of the thing-that-made-you-go-to-the-doctor, including when it happened, how long it’s been happening, does it hurt and the list goes on.  If something makes it feel better – tell us.  If something makes it feel worse – tell us.

Past History
Here’s where you need to tell us about any significant medical history in the past.  If the same problem has happened, that’s fine, but we also need to know about any serious illnesses you’ve had (like glandular fever or syphilis) as well as surgeries.  Even though it’s just background knowledge, there’s a chance that it can help diagnose or treat your problems now.

Medication
Tell us what you’re currently taking, even if it’s not to treat the thing-that-made-you-go-to-the-doctor.

Allergies
This is allergies to medication specifically.  If we need to treat you for something, we really don’t want to be prescribing something you’re allergic to.  That will most likely end-up being the thing-that-made-you-go-to-the-hospital.

Family History
We don’t want to know about your second cousin’s STD or your great-great-grandmother’s goiter, but we do want to know about your parents and siblings.  Unless of course there’s something like Huntington’s Disease in every generation, then it’s probably a good idea to bring that up.

Social History
As far as I’m concerned, this is where a lot of the most helpful information will come from.  It’s where we find out how much you smoke, drink, abuse drugs, how good or bad your diet is and how much you don’t exercise.  Also, it’s where we find out what you do for a living because that’s important!  This is also where we get a chance to see how well you’re doing mentally – people who are unhappy or even depressed often require little prompting before they inadvertently reveal something that alerts the doctor.  He or she might have only said something like: “Can you tell me more about that?”  Boom.  Floodgate opens.

So you can see from this that it’s a pretty obvious chain of questioning, but there is a real art to getting useful responses out of someone who just thinks you’re having a conversation with them.

I would love to master this art someday.