Taking a medical history. Face to face.
By Paul Goldfinger, MD, FACC
One complaint of patients is that medical personnel do not listen well—they are rushed and want to get to the point. They don’t seem interested in the fine details of a patient’s complaint because many times they believe they know the diagnosis within a few sentences. These days, with “team healthcare,” you often don’t get to speak to the physician. Instead you get a medical assistant or physician extender, and they often suffer from the same impatience. But that is not the same as a qualified physician performing the evaluation.
On one occasion, a phone screener/med. assistant, sitting at the front desk of a doctor’s office, picked up a phone call from me and wanted me to describe my pain. This is inappropriate. She is not licensed to practice medicine. There is little reliable information from this uneducated screener that would provide the doctor with any useful insights. In fact it might promote errors.
When I was in training, listening to the patient was a highly valued part of the assessment process. In medical school we took our first clinical course in the 2nd year, and it was called “History and the Physical Exam.”
You can see an example of this in a Blogfinger post called “The Case of the Hypokalemic High-jumper,” when I complained about the same issue:
Medical history-taking in action
This is from the The US National Library of Medicine: ” By the medical history, physicians garner 60–80 % of the information that is relevant for a diagnosis and the history alone can lead to the final diagnosis in 76 % .” And, they say, “Students, having passed specialized history taking skills training, ask relevant questions and structure their interviews well. They are better at responding appropriately to patients’ verbal and non-verbal cues as well as being able to elicit greater quantity and quality of information.”
One of the greatest cardiologists in the history of American medicine was Charles Friedberg, MD, Professor at Mt. Sinai School of Medicine in NYC. When he made rounds on the teaching service, the house-staff had saved the toughest cases to present to him. He would walk into the patient’s room followed by a small crowd of young white-coaters. He did not want to hear a long case presentation. He just sat down at the bedside, near the patient’s head, and began to take a skillful history. He always found some clue that we had missed, and such insights usually led to a beneficial change in diagnosis and/or therapy.
So if you find a medical professional who will patiently listen to your story, consider yourself to be fortunate.
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