if its something that I've learnt so far, is that other than the biomedical knowledge they teach you in 1st and 2nd year, interview/history taking skills clearly fall short.
They use to say, be sympathetic, empathize with the patient, ask your open ended questions to get ALL the information. What they didn't say was, when do I stop the open ended questions? when is it ok to interrupt the patient and ask questions that you so desperately seek answers to, so as to get a clear and detailed picture as to the events that precipitated and the presenting complain itself.
As it turns out, empathy for patients dosen't really matter in the end. Get the information you want, and start processing and thinking about what's wrong. However, the patient feels towards you is irrelevant, if they need you to make their life better, they won't hold back information from you no matter how big a prick you appear to be.
Lesson no.1
Start with the open-ended question.
'Hi, can you tell me why you had to come to the hospital?"
Pain? - character of the pain, quantity of pain, radiation of pain + associated symptoms. What made it better, What made it worst?
Think about possible symptoms involved in the presentation, and illicit all risk factors and systems review(prioritize questions) as soon as possible. The patient having High Cholesterol is more important than the fact that he had a hip replacement 15 years ago. What happen before the patient fell thru the roof is more important then the fashion in which he fell or how many bones he had broken.
6 minutes, thats about all the time to take a complete yet focussed history, before taking another 6 minutes to do an examination of the relevant systems.
In the meantime, I'll be busy memorising the 1 million causes of clubbing, the dynamic heart manoeuvres, the signs of severity of AS/MR.
7am CBT this morning, now I'm totally shagged out, with more study to do.
Think 3rd year is slack?? think again...while the intensity is manageable, the volume is surely intimidating.
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