patient told me “doc, you are the fourth one I have visited for this problem and you are the first one who asked me what my problem is and waited for me to say it. The others just told me what my problem is and what they were going to do about it” this was completely surprising to me. For I had been taught that listening to the patient or taking an history as we call it is the first step to diagnosing on every medical course I have attended. It is has been drilled again and again that I was literally surprised that people are not doing it anymore. And then on second thoughts I thought I understood why. There has been a tremendous explosion in the field of medical investigations recently and doctors have so much of data and information on their hand even before they see a patient that its literally possible to just read the reports, go through with further investigations if needed, diagnose and cure a patient sitting at home without ever touching them or even seeing them.
The problem with my patient today was that she gave a very specific history of Streptococcal sore throat – with all the classical presenting symptoms like fever, sore throat, glandular swelling and especially Odynophagia- burning sensation in the throat on ingesting anything. It’s a failry standard disease with broad spectrum antibiotic therapy as first line treatment. But the others had dismissed the patient with a “uh! It’s a common cold, go take some anti-histamines and steam inhalation”. I was a little in doubt with my own diagnosis when the patient told me this- three stalwarts off the profession versus junior me? Fortunately I had a Medscape App on my smartphone and I confirmed my diagnosis with WebMD. There it was on the very first line Odynophagia=strept throat. Fully reassured, I came back from the pretext of getting water to drink which I used to leave the patient alone for a minute to check online and with confidence restored in my diagnosis, handed over a prescription for a broad spectrum antibiotic and advised her to come definitely for review after the mandatory 5-day antibiotic course.
The point I am trying to make does the fact that we have superior technology really excuse us from using our ears to what the patient really wants to tell us? I know that some of us are rally busy practioners and a lot of patients have this tendency to ramble along on multiple tracks confusing us with multiple diseases all at the same time (for a single fee…), but can’t we just prod them along the right path to stick to the primary disease in hand? Instead of switching off completely form them and letting them feel that we are just not interested in what they have to say? I mean you can even charge them for “listening time”. But why don’t you give them a chance to say what they really want to say to us? It’s their disease not ours and they know it better, don’t they? They literally live with it. We just offer a opinion and get paid for it to boot. where is your sense of mystery and excitement? Are we that jaded in our professional lives? Are we too turning into diagnostic machines?
I wish my readers would really help me out on this with their suggestion and advices…