Sometimes getting a history is a challenge. Take this morning for example, I was (to my own down fall) distracted by the urine sample I was presented with when the patient came into my room. If I had looked closer in his notes and been less distracted it would have saved me a lot of time.
The elderly chap with the sample, tells a woeful story of sleepless nights, getting up hourly to pee. The sample is clear, so we start talking about Prostate troubles. He seem interested, taking it all in, and mentions that he has had a TURP in the past. So only then do I slip off the gloves and look to the computer. There is his repeat prescription for Flavoxate for his urinary frequency, so I mention this to him.
“Oh” he declares “am I supposed to be taking them?”
Other times getting a history is easy, but why are you telling me this? Yesterday for example…
“How can I help?”
And so it begins….
“I had a blood transfusion in 1973…”
(and the history stops)
“Well I came up in a big rash and they stopped the transfusion straight away”
The history stops again – ohh, it must be my turn to speak again… Hmm where is this leading? – Does she think she is still anaemic because of an incomplete transfusion 33 yrs ago? Oh my god, is the rash still there??
No really can’t think of much to say, so resort to a blunt but polite:
“So why is this concerning you today?”
and so comes the answer, but still not much clarity…
“Well, I was worried about Hepatitis”
Oh my god!
Did she have the complexion of an extra off “The Simpsons” ?
Did she drag her fatigued body in whilst clutching her right upper quadrant?
Was she bogged down by oedematous joints covered in more spider naevi than a paint baller.
Urrr – no actually.
Was she in fact completely asymptomatic?
So why did she come? What where her concerns?
It turns out that Anita Rodderick, founder of the Body Shop has Hepatitis following a transfusion in the ‘70’s
Does this mean I can expect every patient that had a transfusion in the ‘70’s to attend this week?
Now if only Anita had worked more on a business that “does what it says on the tin”
“Hi, could I have a fair trade liver replacement please, and those boobs are on offer so that’d be great too thanks”
Anyhow can I expect similar attendances?
Men who drove car’s in the 1950’s expecting to die in a car accident, because James Dean did?
Or drove around in the 1960’s expecting to get shot, because JFK did?
Or people who have been hit on the head by an apple going on to develop Bipolar disorder, because Sir Isaac Newton had it? (The whole apple hitting him on the head thing is a myth anyhow)
OK I’ll stop now. She had a concern and did the right thing coming to get an opinion about it. I was polite, I reassured, I did not give her my true opinion on her though, she may have been upset.
History! Let’s hope the patients can keep it to a relatively recent collection of related events. Of course my favourite is:
“I’ve had it for a while”
How long is a while?
“Oh, a good while”
“Oh, quite a while really”
Let’s try to break it down, a week, a month or a year?
“Ooooh, probably about that!”
Do you get the pain when I bang your head on my desk like this???