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History lessons

The longest consultation with a doctor I have ever had happened only recently. It was my first Genetic Clinic appointment and the doctor took my medical and family history for over 2 hours. The doctors in that clinic routinely take exceptionally thorough history during the first consultation in order to ascertain if patients’ conditions have any genetic component to it. The ‘thoroughness’ is also needed to help them narrow down the specific gene responsible for the patients’ conditions from over 25 000 genes to just a few.

People are trapped in history and history is trapped in them.

James Baldwin

I am not trying to imply that all doctors should take such detailed history from their patients. That would be nearly impossible given that all doctors are pressed for time. It may even be unnecessary depending on the presenting complaints of the patients and the context of the presentations. Neither am I implying that longer history taking means better history taking. But, I believe a thing or two I learnt from the doctors that day could supplement what we have all been taught about history taking in medical schools.

Set the stage and let the patient speak

When patients walk into the doctors’ room, they expect doctors to have read their referral letters or their previous case notes. That is the ideal situation to start guided conversations with patients, but not all doctors have the time to do that. And that’s okay, as long as you are honest and apologetic about it. What is more important than having read that information is to set the stage for the patient so that they feel compelled to tell you their stories. Let them speak. Often you’ll get far more valuable information than those provided to you in the letters or notes.

Address the accompanying family member

Don’t ignore the husbands, the mothers or any family members accompanying the patients for that matter. Ask them appropriate questions and acknowledge their presence and support for the patients. Addressing them would not only make them feel better, but it makes the patients feel more comfortable to tell you their stories too. Remember that the family members are also valuable sources of information to you, and they may just help you figure out what is bothering your patients. So, ask away.

Don’t forget the social determinants of health (SDH)

In the early stages of getting patients’ history, focusing on chief complaints is wise. But in the later stages, one must not forget to ask questions pertinent to social determinants of health (SDH) relevant to the patients. It is important to clarify with your patients about their living conditions, their jobs, their support systems and their access to healthcare services. The SDHs are exactly that, the social aspects of patients’ lives that will determine the current and future state of their health. It must not be taken for granted or even overlooked.

Don’t overestimate your patient

Most patients you meet these days are well informed about their health conditions. Some because they are doctors themselves, others because they’ve done a fair amount of researching prior to meeting you. But don’t let all that fool you. Just do your thing and ask questions when taking history as if your patients do not know a thing. It is potentially dangerous to assume that your patients know everything about their conditions and would have told you everything relevant to it. It is your duty to ask them the details.

Asking the right questions takes as much skill as giving the right answer.

Robert Half

Let me know if this post has been a useful and practical reminder for your daily patient encounters by dropping a comment below. Don’t forget to share so others could benefit from it too. As always, thank you for reading.

Photo by Matthew Henry from Burst



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