One of the most important things they try to drill into our heads at Med School is the ability to take a good, relevant history. If we get a question in a test or exam asking, “Patient X has these symptoms, describe the steps you would take to reach a diagnosis” and we do not start with Take a relevant clinical history, we’re pretty much screwed.
The importance of a history is not exaggerated. Apparently some UK study indicated that over 75% of diagnoses can be made on a good clinical history. I am still scouring Google for that study, so if you know it do pass it along.
Anywho, listening to a patient is not as easy as it may seem. Another elusive study quoted by a lecturer states that on average, doctors can’t go for longer than 18 seconds before interrupting a patient. At the same time, you can’t sit and twiddle your thumbs waiting for a patient to blurt, “I think I have primary hypothyroidism because I’ve been gaining weight and having a deeper voice since delivering my baby so probably is postpartum thyroiditis!”
[Yes, I have been studying Endocrine System today.]
So anyway, in order to teach us this valuable skill, we have weekly roleplay sessions in which we practise taking histories on fake patients. In front of our groups. Behind a one-way window. And we’re not sound-proof. It rattles you, but it is extremely helpful. Afterward the “patient” and the rest of your group give constructive feedback.
Week 1: We learn about the basic structure of the anamnesis (the fancy word for a history). We practise a bit and get a fright because one actually needs to know stuff in order to know what to ask. AND you can’t get awkward when a patient shares intimate information because you are now there confidant. In fact, you need to get them to share those details without feeling judged. We leave feeling a bit out of our depth.
Week 2: A few unlucky victims are chosen to be doctors. We learn from each other: mind your body language, mind the way you greet your patient. Mind the way your eyes stretch when she says she smokes ten packs a day. Be sure to show your patient to his chair, so he doesn’t accidentally sit in your chair. But if that happens it really is not the biggest trainsmash. Remember your structure. Structure, structure and strucure is what we get out of this session. Don’t float around aimlessly. Have a recipe. Have direction.
Week 3: I get a turn to play doctor. I have taken histories at community service day-clinics before; but it does not do much to ease my mind. I have a recipe. I have direction. The feedback is initally positive. I asked everything. But my “patient” is a nurse and she gave me several cues to follow. Instead, I stuck rigidly to my structure and asked what I wanted, when I wanted. So while I eventually got to all the aspects of her case that I wanted, the discussion didn’t flow. Take a cue if it is offered.
So a good history turns out not to be merely about listening to your patient. Nor is it about having a list of things to ask, or about only getting all the biophysical facts.
Taking a good history is more than a science – it is an art.
Imagine, I actually thought that these roleplays would be a waste of my time…