Making the Right Diagnosis

"The history is the most important thing!"

I still remember those words, spoken by one of my attending physicians in medical school.  An encounter with a patient is broken up into three parts.  The history, or what the patient tells the provider, the physical examination, and review of testing (labs/xrays).

Many believe that the physician should be like Sherlock Holmes, carefully inspecting the finger nail beds of their patients, looking at their tongues, and the soles of their feet.  Then, finally after a period of silence intone the fateful diagnosis:  "You, sir, have Tsutsugamushi Disease!"

It isn't that way.  I know about my patients from what they tell me and the key for me is listening.  Studies show that many doctors interrupt their patients within thirty seconds of them beginning to speak.  Doctors feel that they are "on the clock" and need to come to a conclusion quickly, so they can move on to the next patient. 

I feel these same time constraints.  Still, I have learned that if I let my patients tell the story in their own words, my patient tell me what I need to know in order to come to a conclusion and it really doesn't take that much time.

It isn't just about listening to patients either.  There are many people whose voices contribute to good care.  Nurses, techs, and medical assistants all tell me many things that I wouldn't know otherwise -- things that perhaps the patients wouldn't tell me, but share with them.  It may not even be symptoms, but other things, such as reasons why they aren't taking their medications or, family situations that are impacting their health.

I am just not smart enough to figure out every diagnosis without some help.  Even more, I can't always get a person the treatment that is best for them without understanding, not only their illness, but also, who they are.

It isn't easy to listen.  More often than not, when a person is speaking, doctors are figuring out what to say next or, the next question to ask.

In the end, listening isn't about me, it is about the person in the chair across from me, the nurse at the desk, or the patient in the bed.  As I listen, I will not only identify what my patient's illness is, I will learn who they are and understanding who someone is is sometimes one of the most important things to helping them find healing.