Wednesday, 18 February 2009

History mystery

“In 90% of cases a correct diagnosis can be made with the help of a well elicited history alone”.

Two words – that is all I have to say as a response to this overtly over used statement in Medicine.
You can use your imagination to figure what those two words might be.

Almost a month since my Medicine posting began and I have learnt that histories elicited always has loop holes – always! No matter how many times you go over it and think of the wildest questions to ask, the history is never ‘well elicited’ – which I think is precisely why histories don’t really diagnose 90% of cases.

For my first case discussion I had a patient who clearly explained to me about how he came to the hospital with cough and nothing else. But apparently he came in so breathless he was blue. I asked a hundred times (and I am not exaggerating) about whether he had breathlessness – the answer was always ‘No’.
But on the day of my case presentation when the doctor badgered him about whether he had breathlessness the ‘easily manipulated’ patient completely agreed on having breathlessness which left me with a history worth zilch.

Incorrect history with chief complaint gone wrong – when you have this on your hands it is quite specifically the right time to commit suicide.

For my second case discussion my history was ‘incomplete’ because I did not elicit the history of the exact pattern of ‘waxing and waning’ of the fever the patient had when he was admitted nine months ago. I was apparently supposed to get the day to day, hour to hour history of the fever he suffered from nine months ago. I really do not understand how the patient is supposed to remember such useless (to him) details about his fever when me, being a doctor, cannot remember when I had my last bout of the flu.

Incomplete history leading to inability in reaching a diagnosis only because of the incompetence of the doctor eliciting the history – if you have already committed suicide, do it again.

My third case discussion was a classic. I got a patient who has been suffering from jaundice for the past 30 years and a hernia for 15 years. He had a good memory. My history had everything in it – everything to the point I even mentioned (how, when and why) he scratched his butt every single time he did.
Apparently my history was ‘irrelevant’.
The line between ‘irrelevance’ and ‘incomplete’ is so thin that it really does not exist. It exists only for doctors who are hell bent on giving you a hard time in posting.

Irrelevant history that deviates attention of the doctor from the real complain leading to incorrect treatment modalities – if you have already committed suicide twice, do it yet again.

My fourth case discussion is yet to come, Parkinsonism – in a week's time.
I have faced the consequences of eliciting an incorrect history, incomplete history and irrelevant history.

I honestly wonder what it is going to be this time.
Frankly, I don’t really give a damn.

5 comments:

puneeth said...

awesome

DD said...

too gud! LUV da frankness n da sheer simplicity of it, wich makes it so amusing! :D

rohit said...

ha ha.. so true!

Another Blogger said...

@ puneeth, DD and rohit : Woah! so many new visitors :)
thankyou thankyou..
i guess you guys have some catching up to do...
final year is a pain hence the irregularity in posting.. keep reading!

Kapila said...

this whole history business seems to have taken your psychology/mental stability to task...i always hated history anyways...gud luck with the parkinsons thing (if it hasnt already happened)

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