The first thing that is taught to a med student
when she steps into a clinical posting is history taking. Old timer professors
are of the opinion that a good case history along with a thorough clinical
examination allows the doctor to reach a diagnosis even before any laboratory tests
are done. A quick clinical diagnosis can be life saving for many patients,
hence this stress on history taking. But the main problem arises when different
departments and professors teach different formats of history taking and
students remain confused about which one to follow!
One of our seniors once told us that, there can
be no correct or wrong format of history taking, as it is as much an art as it
is science. At the end, it should help us formulate a clinical diagnosis, the format
that we follow doesn’t matter. I couldn’t agree more with him. Anyhow, in the
initial phases when we are novices in game of diagnosis, having a format to
stick to does help at times. Reaching a diagnosis is like a game of treasure
hunt where you have to find your way to the treasure, and this format can
sometimes be a compass for this journey.
We have to record the history in the patient’s
language as per instructions from our professors. This proves to be a major
problem sometimes, especially when the patient speaks a different language. It
becomes difficult to convey the medical terms to the patient. Since our textbooks
are written in English, at times we end up speaking the English terminologies in front of
patients who give us blank stares while at other times we struggle to translate
terms like “mucopurulent ear discharge” into vernacular languages.
Sometimes even when we convey what we want to
say to the patient, the patient might end up giving wrong information,
especially to training med students, immediately changing their statements when
senior doctors ask. I remember a patient who told me when I took his case
history that he had no hearing loss in either of his ears. I recorded the
history as per the information given by him and presented the case to our
professor. Then the patient, as soon as our professor came to see him, reported
hearing loss in his right ear! I was awestruck. Meanwhile our professor glared
at me and said that I was sure to fail in the semester and started explaining
the case to us. When the patient was sent to the nursing staff for hospital
admission, Sir’s glare finally melted into a smile and he told me, “Never trust them
completely, half the times the patients don’t know what they are talking about.
Next time do all the clinical examinations thoroughly before presenting your case.”
This is a common problem faced by medical students
as well as patients in government settings. While the med students try to learn
as much as possible in their clinical postings the patients are tired of the several batches of students asking them to repeat the same history time and again and
not being able to offer any help in return. This is what makes them
non-cooperative or causes them to resort to malingering in order to derive some
sadistic pleasure from the pain of these dumb students.
At other times it is difficult for us to even
decipher what the patient is talking about as they use terms like ‘chirik’ or ‘jhilik’
to describe pain, terms which no dictionary or even Google can translate for
us. Some patients say yes to whatever symptoms we ask about leading us to
wonder, “How is this person even alive with so many problems?” Many patients,
especially females can’t stop once they start describing their symptoms. You
end up listening to their issues with their husbands instead of their vision
problems or nasal polyp.
If you remember your language classes from childhood, learning “patients’ language” is also similar. You master it slowly and gradually, and eventually learn to reach a correct diagnosis from the limited and often distorted information provided by the patients. So, happy learning!
No comments:
Post a Comment