A Day in the Life ScenariosHuman Interest


In medical school, so many our professors would tell us students, “If you listen closely to a patient, he will tell you what’s wrong with him.” That’s very true and also good advice. Many, many times the patient will actually tell you what’s wrong without actually naming the disorder. The first question a doctor asks a patient is, “What’s going on? What’s troubling you? What symptoms are you having?”

From there, he, or she, will begin the process of telling the doctor what’s going, what’s troubling him, and if the doctor skillfully asks the right questions, the patient will tell the doctor exactly what’s wrong and diagnose himself. 

One example is the young adult who comes to the office with abdominal pain. To begin with he  looks sick and walks slightly bent over, his hand against his lower abdomen. He says he had bad indigestion a few hours ago, but now it has become a constant pain in his right lower abdomen. When he walks the pain is worse. If he sits down hard the pain increases. He has felt so bad he doesn’t feel like eating or drinking anything and is a little nauseated. His bowel function has not changed. Before we do any blood test, urinalysis, CT, or even examine him, we all know he most likely has appendicitis until proven otherwise.

Another, is the woman in her forties who has had a severe, throbbing headache in her left forehead and temple areas. Lights, sounds, and activity increase the severity of the headache. She feels a bit nauseated, lightheaded, and prefers to lie down in a dark, quiet room. Again, before we do any test, especially a head CT, the doctor can be fairly certain the problem is a migraine headache.

Then, there is the elderly gentleman who comes to the doctor with two weeks of pain in his neck, shoulders and upper back. He says these same areas have been very stiff when he wakens from sleep, and it takes an hour or two to loosen up. He has felt tired, weak, less energetic, and mildly headachy. For several weeks, now, he has also had swelling and pain in his wrists. They are stiff and sore in the morning, too. He has taken Tylenol and ibuprofen with little relief. This man’s history is classic for PMR—Polymyalgia Rheumatica, and you write an order for the appropriate diagnostic tests. 

Each of these patients has clearly told the doctor what they have by sharing the set of symptoms consistent with their individual problem. The doctor has navigated the patient through his set of symptoms, and along the way has pinpointed what examination is needed, and what blood tests and imaging studies to order. The doctor, at least one who paid attention in medical school, already has a pretty good idea what the tests will show. 

These are just a small fraction of the clinical scenarios patients can share with their doctor. There are hundreds of examples I could cite, but these give you an idea what the title of this blog means. When a patient is a good historian (ie. can clearly describe his symptoms in an orderly manner, chronologically), the doctor’s job is much easier. It’s the poor historian who just says I don’t feel right and can’t describe his symptoms who makes the doctor’s job much harder and complicated. It helps that the doctor knows the symptom complex of these disorders. 

So, when you see the doctor, tell him/her your symptoms in chronologic order and describe them as clearly as possible. He/she will will be very happy you’ve made his/her job easier. 

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