The History Mystery

The last thing I expected to learn during my outpatient internal medicine rotation was how to take a history again. I mean, didn?t that get hammered into us the first two years of medical school? Ask open-ended questions and cover all the systems. Yes, it may take 20+ minutes, but at least I won?t miss anything and the patient can talk about each and every thing that?s bothering them.

Unfortunately, I?m learning that this way of taking a history is just not efficient when you only have 15 minutes with a patient to take their history, perform a physical exam, formulate an assessment and treatment plan, and schmooze a little. So not only am I constantly looking up different drug mechanisms, dosages, and side effects, I?m taking note on how to keep myself and the patient focused during the interview process.

15-minutes1

There exists a delicate and balanced interplay between establishing rapport, staying directed, and not seeming rude by ending conversations about a range of unrelated topics that could easily take all afternoon. My current preceptor said he took a class in graduate school called Consultation Strategies, which involved completing social tasks within a certain amount of time. For example, one would have to enter a room with someone already in it, engage them in conversation, extract needed information, and politely exit the room. This has helped him maintain his patient flow effectively.

When I first arrived at my preceptor?s outpatient office, I was told that the motto was ?1, 2, 3, Save Lives!? and I could be expected to chant it before entering a patient?s room. Catchy enough and definitely reflects a physician?s goal. But I think the motto could also be changed to ?1, 2, 3 Efficiency!? More reflective of what I?m learning here and, plus, it rhymes.

It?s easier for me than for him to forget that being a doctor is also his livelihood. I want to talk to the patients at length about diseases that I?ve never encountered before, except in books. My preceptor wants me to learn how to be efficient and focused while still addressing the concerns of the patient. Granted, some will take 5 minutes, while others will take 30 minutes. Somewhere along in my career, I will develop my own equilibrium between these two arms of primary care. But at this point, if a patient comes in with extensive neurofibromatosis or newly diagnosed adult polycystic kidney disease or erythropoeitic protoporphyria, I don?t mind if my preceptor enters the room to see me still chatting about symptoms.

Source: http://blogs.palmbeachpost.com/becoming-a-doctor/2010/10/04/the-history-mystery/

Jill Duggan Palm Beach Jill Duggan Palm Beach Florida Jill Duggan Florida Jill Duggan Palm Beach Woman Jill Duggan Palm Beach Woman Magazine