I love it when the lecturers say the same thing: “Take a good history…”
They act as if we don’t know what questions to ask. Don’t they get it?
The right questions are written on the template. But sometimes I just
didn’t know what to do with what the patient told me. Let me give you an
As I entered the room my eyes went immediately to the elderly lady
sitting halfway off the chair beside the bed. She appearing as if she
was about to slip off onto the floor at any moment. I introduced myself
and reached out to shake her hand, but her hands were occupied gripping
the seat in an attempt to support her weight while lifting her hip off
“Can we pleeease feed that little girl in room two,” the nurse pleaded.
“Her mother is driving me craaazy asking if she can go down to the
vending machines and get something. I think she needs to smoke and needs
an excuse to leave the baby with the dad. All she has is a bladder
“Hey sweetheart,” I said, interrupting my wife’s thoughts as she
concentrated on writing her blog. “How would you rate me? You know, as a
It had been a long day when I sat down by the roaring fire to enjoy a
glass of red wine. My father-in-law, who lives with us now, sat down
nearby and began to describe his worsening, but stable angina. While
attempting to pay close attention to his story I began to notice
something strange that I initially mistook for the effects of the wine.
“That’s it! I’ve had it!” I shouted to the air, throwing the envelope on the floor.
“What is it now?” my less-than-sympathetic wife said, dramatically emphasizing now.
“They’re already hiking our taxes, that’s what,” I said, rising from the breakfast table and starting to pace.
One of the greatest benefits of being the executive editor of Emergency
Physicians Monthly is that I get to read Greg Henry’s column before any
of you do. I get to laugh at his unending wit, look up all the Latin
phrases I’ve never heard before, and occasionally censor some of his
more bawdy phrases. But I never cease to be challenged. This month,
Greg’s column on “maturing the physician career” is so important that I
want to use this editorial space to give a resounding “Amen!”
Last month, I wrote about the innovative treatment that cured my
mother-in-law of her C. diff. infection (you can read about our
“elegantly icky solution”). We were singularly thrilled
when she recovered, happily overlooking the fact that her problem was
caused by my own overdiagnosis of infection and overtreatment with a
broad spectrum antibiotic.
I’d love to shield the identity of the patient in this story. But I
can’t, and you’ll understand why in a minute. It’s not that I’m worried
about a HIPAA violation or a law suit. After all, the patient was my
mother-in-law. She and my father-in-law – Pop Pop – have moved in with
us . . . so they aren’t going to sue anybody. And while I hesitate to
embarrass my soft-spoken “Mom Mom” with the details of this tale, I have
to tell this story straight. Here goes.
You’ve heard it said that, “Talk is cheap.” Well that turns out to be
particularly true in the realm of health care spending. Studies show
that if you communicate clearly with patients and their families,
there’s a fair chance that they’re not going to want to spend all the
money that you feel compelled to spend.