Wednesday, April 3, 2019

Asking Questions

History taking in medicine is science just as much as art. Here are some tips.

DOs

Open questions: ‘How are you?’ ‘How does it feel?’
The direction a patient chooses offers valuable information.
‘Tell me about the vomit’
‘It was dark’
‘How dark?’
‘Dark bits in it’
‘Like...?’
‘Like bits of soil in it’
This information is gold although it does not cast in the form of coffee grounds.

Patient-centred questions: Patients may have their own ideas about their symptoms, how they impact and what should be done. This is ever truer as patients frequently consult Dr. Google before their physicians. Unless their ideas, concerns and expectations are dealt with, your patient may never be fully satisfied with you or be fully involved in their own care.

Considering the whole: Humans are not self sufficient units; we are complex relational beings, constantly reacting to events, environment and each other. To understand your patient’s concerns, you must understand their context: family, friends, work, dreams and fears. A headache caused by anxiety is best treated not with analgesics; but by helping the patient access support.

Silence and echoes: Often the most valuable details are the most difficult to verbalise.
Trade secret: the best diagnosticians in medicine are not internists, but patients. If only the doctor would sit down, shut up and listen, the patient will eventually tell him the diagnosis.
While powerful, silence should not be oppressive- try echoing the last words said to help your patient vocalise a particular thought better.

DON’Ts

Closed questions: Permit no assumptions. Take no subtle information for granted. Let the patient paint you a picture.

Questions suggesting an answer: The doctor’s expectation and hurry to get the evidence into a pre-decided format have tarnished the patient’s story enough to render it useless.

- Ashish Singh

2 comments:

  1. Brilliantly written.

    Also, a good guide in helping me monitor my conversations is thinking of my patient as my family member - if this was your mother / father / relative - would you still talk to the patient the same way?

    ReplyDelete
  2. This comment has been removed by the author.

    ReplyDelete

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