From: das@canctr.mc.duke.edu
Newsgroups: sci.med
Subject: Re: Reporting Symptoms
Date: 8 Jan 93 02:57:55 GMT
Reply-To: das@canctr.mc.duke.edu
Organization: Duke U. Med. Ctr., Durham, NC

[reply to nyeda@cnsvax.uwec.edu]
>[reply to mdkline@rodan.acs.syr.edu]
>
>>The doctor is interested in obtaining a "chief complaint," which is the
>>starting place in differential diagnosis - the list of all the things
>>that might account for the symptoms.  Tell the doctor the basics -
>>where's the pain, how long you've had it, etc - and let the doctor ask
>>you questions about the symptom(s) - e.g., what makes it better, what
>>makes it worse, is it relieved by X, ever had it before, it is
>>associated with XYZ, etc.  The doctor ought to know what's relevant and
>>what isn't, take your cue from him/her.
>
>I think we worry too much at times about being in control of the patient
>interview.  If a patient wants to do all the talking, I'll let them as
>long as they don't ramble on forever.  The more of the history that is
>in the patient's words, the better the quality.  After they are done
>telling their story then I ask about anything I need to know that they
>have left out.  I also find it helpful for patients to tell me what they
>are worried about having.  Sometimes you do them the most good by
>addressing an unrealistic fear or correcting misinformation about a
>condition.
>
Prior to becoming ill 4+ yrs ago I had little experience with physician
interviewing techniques.  Since that time I have had more than my share
of encounters with physicians who feel they must stay "in control" of the
patient interview and met too few who will allow me to "ramble" for the 5
or so minutes that it takes to cover the highlights of my history.  Often
just giving the major complaint and allowing the physician to direct the
interview results in a hasty diagnosis followed by the ever present

prescription pad being pulled out of some handy pocket but with no real
relief from symptoms for me, the patient, and a wait of 2-4 wks before
the next appointment.  

On the rare occasions where I may have been allowed to state my case
more completely, I have experienced substantially greater relief from my

symptoms.  I will be the first to admit that this mostly reflects a release
of anxiety.  A good relaxed interviewing technique allows me to say 
what's really on my mind without too much embarrassment... sometimes
it takes a few minutes to work up the courage to ask the real question 
you came to ask, you know?  Even if my concerns turn out to be totally

baseless, being listened to and having things explained rationally can
relieve a fair amount of anxiety.  And when there is a cause for concern,
I find I still feel a release of anxiety and lessening of the symptoms when
I realise I'm being listened to, not just "treated".

In short, I'm an intelligent adult and want to be treated that way.  I am 
tired of being treated like a child; to be seen, not heard, to speak only 
when spoken too.  Just my $0.02 worth (hmmm, maybe $0.04...)

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Lora M. LeMosy, Duke University, Durham, NC
das@canctr.mc.duke.edu - or - 71544.467@compuserve.com
I don't speak for the university and they don't speak for me.
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