The art of the medical history
by Lorien E. Menhennett
While translating this week at the free clinic where I volunteer, I helped out with two back-to-back intake appointments. “Intake” meaning brand new patients to the clinic, and meaning the medical practitioner had to take an entire medical and social history before getting down to what was bothering the patient that day. I had translated for intakes before, but never back-to-back ones. Working with them in such high concentration really got me thinking about the importance of taking a good medical history: how it very often provides the tools for making a more complete diagnosis and understanding what is going on physically, and psychologically, with a patient. And how without it, you would be lost.
The first patient, a middle-aged woman, came in with wrist pain. Suspecting tendonitis or carpal tunnel, the doctor asked whether the woman had ever worked in anything where she did repetitive motion. Turns out she used to work with jewelry. Turns out she also had surgery on her other wrist for carpal tunnel many years back. Bingo! The doctor then prescribed anti-inflammatory medication to try and relieve the symptoms, with the hopes that the patient wouldn’t need another surgery. Had the physician not known about the patient’s past, it would likely have taken much longer to make a diagnosis and to find something to bring the patient relief.
A nurse practitioner saw the second patient, a younger woman with rheumatoid arthritis who had been taking a high dose of steroids to relieve her arthritis pain. When it came time to do a “review of systems” — to check her health (literally) from head to toe — she responded with a “yes” when asked if she had a problem with nearly every area mentioned. Headaches, blurry vision, the list went on. It became quite clear that it was the long history of taking steroids that was likely causing all of these problems. The solution? Taper off the steroids and start another arthritis-relieving medication. Again, had the nurse practitioner not asked very detailed questions about her medication history (which he did), there is no way he would have known that her problems were a result of the steroids, and no way he would have been able to (hopefully) resolve the situation.
There are so many things you need to know about a patient, so many things that could affect their well-being. So many questions, many of which may not be pertinent to one patient, but may make the difference for another patient’s treatment. For example, if you know someone has a family history of diabetes, you can keep closer tabs on their sugar levels, and also impress on them the importance of eating right, exercising, etc. Not that you wouldn’t do that for every patient — but you could emphasize that there is added risk because of the family history. And that might help convince them to take their health more seriously.
Listening to the physician and the nurse practitioner take those medical histories gave me a better sense of what I will need to do when I become a doctor. It was good experience for me to be exposed to not only what questions to ask, but how to ask them: with compassion and sensitivity (especially the more delicate questions). Luckily, as a former journalist, I am an experienced interviewer. So I have that going for me. What I am learning is a new set of questions, and how to interpret a new set of answers.