Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Listen to your patient’s story: It’s their diagnosis

Hans Duvefelt, MD
Physician
December 14, 2016
707 Shares
Share
Tweet
Share

Sir William Osler wasn’t exactly wrong when he said, “Listen to your patient, he is telling you the diagnosis.” But he didn’t mean it literally. His patients did not offer up esoteric and complete medical diagnoses on a silver platter. They left him clues in plain language that he listened to carefully in order to make the correct diagnosis.

He penned his words in an era when medical information was scarce among non-medical people. There was no Dr. Google, Dr. Oz or Dr. House to educate the public about diseases or medical terminology a century ago.

In a way, I think doctors today have to do more filtering of what our patients say to get the medical history straight.

For example, Mrs. LaVerdiere made an appointment for nausea some time ago. As soon as I walked into the exam room, she started telling me about how she must have eaten a spoiled crab sandwich on her trip to a coastal fishing village the weekend before. Her conversation was full of theories as to why she was feeling unwell and her husband wasn’t. I finally got her to describe in great detail exactly what she felt, and the gnawing pain that radiated to her back did not fit with a simple case of food poisoning. Her CT scan showed the smallest pancreatic cancer ever diagnosed at Cityside Hospital, and she underwent a Whipple procedure as easily as any routine minor surgery.

Mrs. Waller describes ordinary bodily sensations in the most dramatic terms and throws terminology around that rocks me out of my country-doctor way of plain-talking. She has, over the years, described ordinary itches as “you know how it feels when you’ve been bitten by a thousand fire ants,” headaches as “I felt like I was about to pop a berry aneurysm” and indigestion as “pyloric stricture.” I have the distinct impression she is always trying to make my job easier by describing things in more or less medical terms in case I forgot to speak English.

During my tenure in medicine, the tendency for patients to offer explanations and theories instead of just describing what they feel has increased dramatically since the creation of the internet. But I have come to realize that there have always been people who are simply not able to recognize and describe what they are feeling, particularly emotions. They, therefore, tend to describe the bodily sensations that their unrecognized emotions produce. Or, even harder to decipher, they are only capable of reporting other people’s observations of their own appearance or behavior.

Most of us recognize that anxiety or other strong emotions can cause heart palpitations or abdominal pain. Hence, our use of expressions like ”gut-wrenching,” but some of us are only aware of the bodily sensation and are clueless about the emotions that trigger them. They are also usually skeptical about any suggestion of such a connection.

Hedda Brown is one of those people I have always struggled to diagnose, no matter what ailed her. Only a few years ago did I learn the word for her condition: alexithymia, an inability to recognize emotions. She would answer questions like “tell me more about in what way you don’t feel well” with stories like this:

“I knew I wasn’t feeling right yesterday morning. I didn’t want breakfast. Harry, my husband, took one look at me and said I looked piqued and told me I looked like I was about to vomit. My daughter also noticed something about me. She said I looked like I was dehydrated. She acted real nice all of a sudden, instead of her usual way of ignoring me, she offered to make me a cup of tea or make me an omelet, but I just didn’t want any.”

No matter how much time I give Hedda to tell her story, I get very little to work on. So I usually try some direct questions, like “Did you have chills?” or “Did your belly hurt?” But even that kind of inquiry usually results in answers about other people’s observations or theories.

I have finally come to realize that Hedda carries with her more than a lifetime’s worth of grief, which now and then erupts as a sensation she has no words for. Because she is so unaware of her emotions, the most I could ever expect from her is a general bodily sensation, like “a pain here” or “not hungry.” In the beginning, she underwent a fair number of tests, but as she has started to trust me more, we have had a few conversations along the lines of “maybe your body is trying to tell you something”. It is a slow process.

Thinking about Sir William’s famous quote, perhaps it could be adapted for the Internet age this way:

“Listen to your patient’s story; he is telling you the diagnosis.”

“A Country Doctor” is a family physician who blogs at A Country Doctor Writes:.

Image credit: Shutterstock.com

Prev

Telemedicine: What could go wrong? A lot.

December 14, 2016 Kevin 10
…
Next

This physician gives Trump some health care advice

December 14, 2016 Kevin 11
…

Tagged as: Primary Care

Post navigation

< Previous Post
Telemedicine: What could go wrong? A lot.
Next Post >
This physician gives Trump some health care advice

More by Hans Duvefelt, MD

  • The art of asking where it hurts

    Hans Duvefelt, MD
  • Thinking like a plumber when adjusting medications

    Hans Duvefelt, MD
  • The American food conspiracy

    Hans Duvefelt, MD

Related Posts

  • If I listen hard enough, each patient has a sacred story to share

    Johnathan Yao, MD, MPH
  • The story of how this physician started her blog

    Sasha K. Shillcutt, MD
  • Why everyone needs a six-word story

    Alexie Puran, MD
  • Doctors: It’s time to unionize

    Thomas D. Guastavino, MD
  • What it’s like to write about COVID-19 while it’s killing your mom

    Debra A. Shute
  • Every patient has a story

    Michele Luckenbaugh

More in Physician

  • From medical student to intern: Discovering a deeper connection with patients

    Johnathan Yao, MD, MPH
  • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

    Jennifer Lycette, MD
  • Decoding name displays in health care: Privacy, identification, and compliance unveiled

    Deepak Gupta, MD
  • Master time management with 7 productivity strategies for optimal results

    Farzana Hoque, MD
  • The tragic story of Mr. G: a painful journey towards understanding suicide

    William Lynes, MD
  • The escalating violence in health care workplaces: a critical problem facing the nation’s health care system

    Harry Severance, MD
  • Most Popular

  • Past Week

    • Physician entrepreneurs offer hope for burned out doctors

      Cindy Rubin, MD | Physician
    • Boxing legends Tyson and Foreman: powerful lessons for a resilient and evolving health care future

      Harvey Castro, MD, MBA | Physician
    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • We need a new Hippocratic Oath that puts patient autonomy first

      Jeffrey A. Singer, MD | Physician
    • Unveiling the intricate link between housing costs and health care

      Harvey Castro, MD, MBA | Policy
    • Fixing the system and prioritizing patient care [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • An inspiring tribute to an exceptional radiologist who made a lasting impact

      Kim Downey, PT | Conditions
  • Recent Posts

    • Fixing the system and prioritizing patient care [PODCAST]

      The Podcast by KevinMD | Podcast
    • From medical student to intern: Discovering a deeper connection with patients

      Johnathan Yao, MD, MPH | Physician
    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • Unveiling the global pandemic threat: insights into risk factors and urgent measures for prevention

      Ton La, Jr., MD, JD | Policy
    • Decoding name displays in health care: Privacy, identification, and compliance unveiled

      Deepak Gupta, MD | Physician
    • Empowering Black nurses for lasting change [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 2 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Novel IDH1/2 Inhibitor Shows 'Dramatic Effect' in Low-Grade Glioma
  • Nivolumab-AVD Boosts PFS in Untreated Hodgkin Lymphoma
  • 'You Can't Yoga Your Way Out of This': What We Heard This Week
  • New Standard in Operable EGFR-Positive Lung Cancer
  • New Ovarian Cancer Drug Extends Survival in Resistant Disease

Meeting Coverage

  • Novel IDH1/2 Inhibitor Shows 'Dramatic Effect' in Low-Grade Glioma
  • Nivolumab-AVD Boosts PFS in Untreated Hodgkin Lymphoma
  • New Standard in Operable EGFR-Positive Lung Cancer
  • New Ovarian Cancer Drug Extends Survival in Resistant Disease
  • Neoadjuvant Chemo Flops Versus Upfront Surgery for Resectable Pancreatic Cancer
  • Most Popular

  • Past Week

    • Physician entrepreneurs offer hope for burned out doctors

      Cindy Rubin, MD | Physician
    • Boxing legends Tyson and Foreman: powerful lessons for a resilient and evolving health care future

      Harvey Castro, MD, MBA | Physician
    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • We need a new Hippocratic Oath that puts patient autonomy first

      Jeffrey A. Singer, MD | Physician
    • Unveiling the intricate link between housing costs and health care

      Harvey Castro, MD, MBA | Policy
    • Fixing the system and prioritizing patient care [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • An inspiring tribute to an exceptional radiologist who made a lasting impact

      Kim Downey, PT | Conditions
  • Recent Posts

    • Fixing the system and prioritizing patient care [PODCAST]

      The Podcast by KevinMD | Podcast
    • From medical student to intern: Discovering a deeper connection with patients

      Johnathan Yao, MD, MPH | Physician
    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • Unveiling the global pandemic threat: insights into risk factors and urgent measures for prevention

      Ton La, Jr., MD, JD | Policy
    • Decoding name displays in health care: Privacy, identification, and compliance unveiled

      Deepak Gupta, MD | Physician
    • Empowering Black nurses for lasting change [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Listen to your patient’s story: It’s their diagnosis
2 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...