I completed a casual, unscientific poll of several doctors I work with and asked them, “What do patients say that make it more difficult to determine their problems?”
Here are the top three responses with stories behind them:
“It just hurts”
The guy was in obvious distress so his impatience with a barrage of questions from the doctor only made the pain worse. All he wanted was someone to make the pain go away.
Michael Huckabee is professor and director of the physician assistant program at UNMC. He's worked as a physician assistant for 30 years, primarily in rural Nebraska. He blogs every other week. Read more from Mike here.
When you report any pain, clinicians know the go-to-questions that will define the pain and likely point toward a more specific diagnosis.
"OLD CARTS” is a famous medical school acronym reminding us of the needed questions: onset, location, duration, character, aggravating/alleviating factors, radiation of pain, temporal factors and severity.
Determining whether a belly pain is “knife-like,” or more of a “dull pressure,” can tip the scales toward surgery or cancer or something less serious.
“Let's play a game”
OK, the patient doesn't actually say this, but several doctors reported that some patients want to play “hide and seek." In other words, they withhold information and wait to see if the doctor comes up with it.
For example, a male patient reported a cough to his doctor but didn't seem too concerned about it. After a full history and physical exam revealed little, the doctor asked if there was anything else the patient wanted to add. That's when the patient brought out a letter from the local health department reporting that an exam had suggested he may be at risk for tuberculosis.
If the doctor had that information in the beginning, zeroing in on the patient's concerns would have been much easier.
I remember discovering a breast mass on a patient of mine several years ago. When I asked her if she was aware of it, she said, “Yes, I just wanted to see if you'd find it, too.”
Her diagnosis was cancer, so playing that game can have serious consequences.
“Oh, and one more thing..."
It's understood that you may think of something at the last minute to ask. Because your time with the doctor is valuable and often scarce, you want to take advantage of every moment.
Too often, the casual "one more thing" is actually something important.
“I've had this little twinge in my chest every so often. It's nothing, right?”
When that comes at the end of a visit, the scheduled time has elapsed and your "one more thing" may deserve significant attention that is not available. In this case, it would have been an evaluation of chest pain to potentially prevent a heart attack.