A good history is integral to practicing good medicine

Have you ever gone to the doctor’s office and forgotten what you were going to say or felt like you didn’t have the answers to any of the doc’s questions? Have you ever gone in to an appointment thinking, “I have pain and I am sure an MRI will show the cause,” but your doctor seems to insist on asking you a million questions about your symptoms and doesn’t order that MRI you thought you needed?

Believe it or not, even though we are in the age of rapid testing and imaging, the most important part of making a diagnosis is your story about your symptoms. We call this the “history.” Getting a good history is integral to practicing good medicine, particularly in primary care.

Imagine this. A man is walking down the street and witnesses a mugging. He is standing there watching the whole thing, but is unable to get involved because the perpetrator has a gun. After the incident, he calls the cops. Pretend you are a cop. What would you ask the witness?

“Where did the incident happen?”

“What did the suspect look like?”

“What was he wearing?”

“What time did this occur?”

As a police officer, what would you do if the witness said, “I don’t know” to some answers and, “I think…” to others? It would be hard to put together the story or to feel confident about it, wouldn’t it?

The basic ideas of getting the “Who, What, When, Where, Why, and How” are important to any kind of detective work. As a physician, I am generally supposed to answer the “Why” and “How” parts. The rest is up to you. Not to put pressure on you as a patient, but because I am not going to run every test known to man in order to come up with the diagnosis, I rely on the information you give me to figure out the appropriate next step.

Here’s a tip:

Tell your story your way, but include the important details. How do you know what is important? Well, I will tell you and you will likely see that it makes a lot of sense.

Pain is a great example of a symptom that is best evaluated initially with a certain set of questions, rather than jumping to x-rays or other imaging. Let’s say that, for example, you are seeing your doctor next week for a pain in your foot. Try to remember the following for that visit (write it down if you are worried you might forget):

  • Where exactly in the foot is the pain?
  • What makes the pain worse?
  • What makes it better?
  • When did the pain start? (dates, exact or approximate help)
  • How did it happen? (after a night of dancing in heels, for example)
  • Is the pain sharp (like a knife) or dull (like an ache)?
  • How severe is the pain?
  • Is the pain constant or does it come and go?
  • What have you tried to do for it already? (medications or exercises, changing shoes, etc).

The beauty of going through these questions yourself is that it not only helps me figure out what is going on, it might even help you figure it out before you even need to see me. I am not talking about self-diagnosis, necessarily, but it may help you keep the pain from getting worse or perhaps make you realize that a certain pair of shoes is not right for you. In our busy world, we often forget to pay attention to little details. Trust me, I have seen patients come to me for help and then come up with the answer themselves as they are talking to me because it is the first time they sat down and actually thought it through.

No matter how you describe your symptoms, I am still going to do my best to put it together and come up with an accurate diagnosis with as few unnecessary tests as possible. It is my job, after all. But sometimes, how you tell your story can help me help you better .

Linda Pourmassina is an internal medicine physician who blogs at Pulsus.

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