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Well. Obviously.

12 Sep

You know, we don’t mean what we think we do when we ask about past medical history. First, there’s a handful of common conditions that almost nobody lists as part of their medical history, like hypertension and hypercholesterolaemia. Those are at least sort of understandable. But people don’t think that arthritis is a medical condition, especially if they’re quite stoical west of Scotland types like my patients tend to be. They never think that an ‘operation’ is a ‘medical condition’, even if it was a CABG. They often forget about their diabetes, and, unlike hypertension, that doesn’t naturally reveal itself from the drug history because insulin isn’t a tablet, so, in their heads, it might not necessarily count as a medication. My jaw nearly hit the deck the first time someone made it clear that they didn’t think of their COPD as an actual disease, but it turns out that that’s not so unusual. And on and on and on.

Then, you get the huge glaring gaps in medical histories that nobody could possibly have anticipated.

I was sent with the rest of my clinical practice group to speak with a gentleman who had been admitted to the stroke ward a few days earlier. There are few things more awkward than four people trying to take a medical history all at the same time, and so it was decided that one person would take the history and that the rest of us would observe. The gentleman told us that he had been feeling well throughout the day and had been watching television when he became aware of blurry vision and a heaviness in his right arm, and, thinking that he was having a stroke, had gone and knocked on his neighbour’s window. He had realised then that he couldn’t speak, but the neighbour had called an ambulance and he had been brought to A&E. The guy who had volunteered for the firing line asked about the specifics of his inability to speak, and then asked if there had been any symptoms in his right leg, if he had had a headache, if he had blacked out, if anything like this had ever happened before. It all seemed to be going well. He moved on, asked about any other medical conditions and any past medical history — it was after this that I started asking, “has your doctor ever told you that you have high blood pressure or high cholesterol?”, because we do need ways of getting around the obstacles in the first paragraph and I liked that question and it works. He asked about family history, about medications and social circumstances and smoking and alcohol intake and recreational drugs.

Finally, he asked, “Sir, can you take me through exactly what happened on the day you were brought into hospital just once more?”

“Well, I got home from my radiotherapy at about lunchtime…”

Collectively, we wondered if we had misheard that.

“Right,” he said. “Okay. Um. If you don’t mind me asking, what is it that you’re having the radiotherapy for?”

The patient looked at him as if he might have a screw loose. “Well, for my lung cancer.”

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2 Comments

Posted by on September 12, 2010 in Blog, Medicine

 

Tags: ,

2 responses to “Well. Obviously.

  1. Catriona

    October 3, 2010 at 6:01 pm

    I’ve experienced something like this myself!

    Young male, in A+E with a presenting complaint of diarrhoea and vomiting. When doing past medical history, he mentioned his previous admission for diazepam overdose but nothing else. On examination, he lifted up his top and he had a midline abdominal scar and other smaller ones. He’d been stabbed and needed an emergency laparotomy and didn’t think to mention that…

     
    • sefkhet

      November 18, 2010 at 3:56 pm

      And the patient who told me that she wasn’t taking anything for pain. No, she didn’t take tablets. No, nothing at all.

      Well, no, not nothing, she was taking paracetamol.

      Oh, and Sevredol.

      And now she came to think of it, yes, her GP had put her on morphine.

       

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