‘Listen to your patient he is telling you the diagnosis’
Really Sir William? Maybe where you worked, but the denizens of my practice area rarely tell me anything that useful.
As superb a physician as I’m sure Osler was, I’m not sure what he would have made of the verbal offerings from our practice list:
‘So how long have you had this pain?’
‘A long time’
‘So how long would that be?’
‘Oh let me think, mmmm, quite some time’
‘So is that a week? A month? A year?’
‘Yes’
It’s not just the vague which frustrate, there are those patients who give what I call the ‘deconstructed medical history’.
Like a toddler’s model built from clay, they have constructed a crude idea of the diagnosis in their heads, but instead of handing that over as a starting point, they pull it all apart and randomly throw pea sized chunks of it at me.
Descriptions of chest pain will be interspersed with complaints about discoloured toe nails and patches of dry skin. It sometimes feels like these patients have emptied a black bag of refuge on my desk and asked me to pick through stinking detritus to find all the segments of a torn up piece of paper with their diagnosis written on it.
Finally there are those patients who seem to have taken Mark Twain’s famous quote ‘I didn’t have time to write a short letter, so I wrote a long one instead’ rather too much to heart.
You all know this sort, whatever the problem be it a changing skin mole or claudication, the history is always going to start with a detailed description of the post office queue last Thursday and a blow by blow account of the conversation with the receptionist that was needed to secure the appointment, half of which has now been wasted with them moaning about the screaming kids in the waiting area and the fact a fat man in a builder’s van was parked in the disabled space.
It’s no use interrupting either, that just pushes rewind and they start again from the beginning.
Mind you, concise and cryptic can be just as challenging:
‘I’ve not been piss-proud* in months can I have some blue happy pills** please?’
Took me a while to decipher that one.
Dr David Turner is a GP in west London
*no morning erection
** sildenafil.
