Although a lot of people expect their doctor to figure out what’s wrong with them by doing a physical examination, in reality doctors figure most of it out by listening; simply listening to what the patient says. That’s why we ask so many questions… well, unless you’re a dermatologist I suppose, in which case you just walk in, look at the patient’s skin, and ask the patient to be quiet. But for the rest of us doctorly-types it’s mostly about what you patients tell us. And although I love using electronic medical records and a variety of digital resources, I am certain that no technology will ever replace listening as the most important skill needed for making a correct diagnosis.
We call this question and answer part of the doctor visit “taking a history.” It’s an art form really, to do it right, and a fun challenge that usually leads to me understanding what is wrong with the patient, or helps the patient and parent realize what is going on. And sometime a careful history yields quite unexptected results.
Like this… A second grader was brought in by his father this week. Dad was worried his boy might have a throat infection or asthma. The boy’s school sent him home the other day noting that the child developed trouble breathing while coughing a lot, then he turned very red in the face. The father informed me that it is “a Lutheran school where they apparently burn incense,” but that’s all he knew about the incident, and all the school told him. Well that didn’t sound right, I mean I knew this kid all his life and he’d never shown even a hint of asthma, so I asked a few more questions and here’s what the young sinner told me; “We were in first period, at chapel, and you know that place where the priest stands, that’s where the teacher was and we all had to write down a bunch of times what we shouldn’t be doing in class, then he took all the papers and put them into a can and then he lit the can on fire with a flame, and all this smoke came out and everyone in the front row started choking and coughing, and I turned all red so they made me leave and called my dad.”
I wrote a prescription out immediately: One pea-shooter, use as necessary, avoid eyes.
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