Patients say the darndest things.
Sometimes, a doctor asks a routine question, one that she’s asked to others many times before, and gets a completely unanticipated answer. That’s why it’s important for any provider to ask questions as clearly and completely as possible, and clarify answers. Otherwise, the patient might be answering an entirely different question than the one you asked.
Occasionally that would happen to me when I saw gynecology patients in the emergency room. I asked every woman whether she was sexually active. Most answered either yes or no, but every now and then, I would ask, “Are you sexually active?” and the patient would say “No, I don’t move around much during sex.” or “Not active enough, if you asked my boyfriend.”
Questions asked and answered are important, but sometimes what is not asked is even more important. That’s why any provider should go through what is called a “review of systems” when taking a history. A review of systems means asking specific questions about most major aspects of body function. You can ask, “Do you have any medical problems?” and the patient will say no, but a review of systems often reveals a great deal of important information that may have been left out..
The typical case from my internship was a woman I was interviewing prior to her scheduled surgery. She insisted that she had no medical problems. I was in a rush and did not go through a review of systems. When I began her exam, I was surprised to find a large scar in the midline of her abdomen.
“What’s that from?” I asked.
“Oh, I forgot. That’s from my hysterectomy.”
“When did you have the hysterectomy?”
“Hmmm. Let’s see. That was last February. No, wait. I was supposed to have a hysterectomy last February, but they had to postpone it because of my heart attack.”
“Your heart attack?”
“Yes, I had a heart attack, but then they did angioplasty and I felt a lot better.”
“Angioplasty?”
“Yes. Then they rescheduled my hysterectomy, but I broke my leg …”
It is truly amazing what patients will forget to tell the doctor. A colleague admitted a woman who was 25 weeks pregnant to the hospital because she had a fever of 105. When giving her history, the patient insisted that she had no known medical problems. When the doctor examined her, she was shocked to find a very large incision extending from the base of the patient’s neck to the bottom of her breastbone.
“What’s this from?” the doctor asked.
“Oh, that. That’s from my heart transplant.”
The doctor was incredulous. “Your HEART transplant.? Don’t you think that’s a medical problem?”
“Sure,” said the patient, “you asked me if I have any medical problems, but I don’t any more. The heart transplant fixed them all.”
Not surprisingly, the heart transplant was a relevant piece of information. The patient was taking immunosuppressive drugs that left her vulnerable to serious infection. Knowing that, the doctor started her on broad spectrum antibiotics, and she recovered quickly. Sometimes, what you don’t say it just as important as what you do say.
Everyone should keep a list of their past medical history, past surgeries, current medical problems and current medications. Be sure to share that information with your providers at the beginning of any consultation. The recommendation that your doctor offers is only as good as the information that she has available. Ensuring that your doctor has accurate and comprehensive information about you and your health is the first step toward getting the best possible care.
