Monday, October 17, 2005

It's All in the History

In medical school I was frequently reminded that the medical history provided 80-85% of the diagnosis of any patient, hence history taking was a skill that we were encouraged to practice. However, I often observed that there were occasions were relevant information was being witheld by the patient, whether intentional or not.

Things haven't changed. Last night during my 2nd duty at Dr D's Clinic, this is what happened:

(Enter a 30-40 year old lady)
Rygel: (she appears to be in good physical health) Good evening Ma'am. How may I help you?
Patient(Px): I've been having difficulty in swallowing.
Rygel: (might be tonsilitis) Do you mean you're experiencing pain in swallowing? How long have you been experiencing this?
Px: It started 6 days ago. I tried all sorts of remedies but the pain won't go away.
Rygel: (must be tonsilitis… she seems to have difficulty turning her head) Did you experience other symptoms?
Px: (keeping head looking straight ahead) I've also started to experience pain whenever I turn my head to either side.
Rygel: (it could be torticolis (stiffneck)) How long have you experienced this?
Px: It started 3 days ago.
Rygel: (a simple stiff neck shouldn’t last that long…. Takes our a penlight) I'll be examining your throat now. Please open your mouth and stick out your tougue
Px: (opens mouth with difficulty)
Rygel: (shine's light on patients throat… tonsils are not inflammed or swollen… hmmm)

(Dr D steps in)

Rygel: (refers patient to Dr. D)
Dr D: Good evening Ma'am, I'm Dr D. I've been told you've been experiencing pain during swallowing.
Px: Yes, It all started 6 days ago when a fishbone got stuck at the back of my throat.
Rygel: (#_^*&%#^@%.... *sigh*.... smile)
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