I need to take my role as historian very seriously

Historians are left forever chasing shadows, painfully aware of their inability to ever reconstruct a dead world in its completeness.
-Simon Schama

“Tell me about your prior cancer treatment,” I say. “When did you have the surgery and radiation?”

“It wasn’t a surgery,” He tells me emphatically. “It was a biopsy.”

“But the doctor SAID it was a surgery!” chimes in his wife.

“Yes, Dad. You have a long scar on your neck,” adds his son.

“No! They called it a biopsy, NOT a surgery! And it was two years ago.”

“No, dear, it was five years ago.”

“Five? Are you certain? That long ago? And I had radiation before the biopsy.”

“No, Dad, you had the surgery before the radiation treatments, remember? You were still recovering from the radiation when the twins were born. And they are four already.”

“Are you certain?”

“Anyway, Doctor, he’s been losing weight.”

“No, I haven’t!”

“Harold, your clothes are hanging off of you!”

He scowls. Things get worse.

Harold is the type of patient physicians tend to call a “poor historian.” He can’t remember his health history and has difficulty connecting the dots between his symptoms and his illnesses. It is hard to get people like Harold to answer health-related questions in a format that is easy to understand and record.

However, an essay by Dr. Jeffrey Tiemstra puts Harold and patients like him into context for me. In a clever and insightful piece, Dr. Tiemstra reminds us that it is not the patient who is “the historian,” it is the doctor.“The historian sorts and organizes the past, identifying the important and meaningful events from the trivial, and then interprets the story in order to explain the circumstances of the present.” That, I agree, is my task.

It is my job to make sense of the events told by the patient and his family. It is my job to create a record of his prior health so that our team move forward and safely develop a plan to help him.

Fortunately, there is a lot of the information in Harold’s records from the outside hospital. I hope they are complete and accurate. Those documents should help me make sense of what I am hearing from Harold in bits and pieces.

I lean back and listen to the family interact. There is a lot of history in the way they talk to each other. Some days more than others, I need to take my role as historian very seriously.

Bruce Campbell is an otolaryngologist who blogs at Reflections in a Head Mirror.

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  • ninguem

    Dr. Tiemstra wrote that article in 2009.

    Joseph Sapira MD, and Jane Orient MD, pointed out the same in “The Art and Science of Bedside Diagnosis” (Williams and Wilkins), nearly twenty years earlier.

    ==========

    from page 18 in the first edition in 1990:

    The word “history” comes from the Greek “historia”, meaning inquiry, which was the title of the earliest extant historical work, written by Herodotus. The practical point is that the historian does not live the history, but records it, as Herodotus did………. When we read in the case record of a “poor historian”, this refers to the same person as with the term “poor auscultator”, or “poor ophthalmoscopist”……… if ” poor historian” refers to the patient, it would mean that he is in impecunious student of the past, a piece of information that belongs in the social history, not following the statement of reliability…….in other words, the physician is the historian.

    What that historian might have meant to say by his phrase “poor historian” was that the patient has difficulty remembering. Such a memory problem is a biological event, like fever or tachycardia, and is equally deserving of an explanation. To know the patient’s difficulty in recounting his story the same way on any two sequential attempts, or his inability to remember material of the types of most patients would be expected (by us) to remember, should be the beginning of evaluation, not its termination. These observations should suggest to the position the patient may be suffering from an organic brain syndrome. Suspicion should also be aroused if the patient’s performance is variable or fluctuating, or if he is disorganized, shows lapses in concentration, or confabulating, often to the annoyance of the physician. The physician is obligated to determine whether the forgetfulness is in fact due to such a syndrome, then to find out the etiology of the syndrome, so any potentially reversible problems can be treated.

    ==========

    Pointing out, basically, that obtaining the history is really part of the neurologic examination.

    It is now “Sapira’s Art and Science of Bedside Diagnosis”, Jane Orient has taken it over, and I believe it is in its 4th edition.

    I recommend it highly.