Frustration With Poor Historians

In PA school at our end of rotation OSCE’s I was always excited and felt really prepared for my patient experience.  After all, the history and physical exam is the bread and butter of medical practice.  I loved the feeling of being able to solve a puzzle and put a treatment plan into action.  A great Physician once told me that a diagnosis can be reached based on History alone–implying that the history is the single most important part of what we do!

However, what we do in practice doesn’t always match reality.  The patients that we see in real life are not standardized patients or our lab partners for H&P.  A lot of the time the patients that I seen real life have very little idea about their medical histories and don’t provide an accurate history.  They aren’t able to tell you what tests they have had done, why they take medications or even the names of these medications.  It’s frustrating.  When I find a “good historian” I get really excited that I’m actually able to put pieces together based on what a patient is telling me as opposed to sifting through their chart for endless amount of time.

I can’t help but ask myself why do so many patients have no idea what is going on with their health?  Do people simply not care and they just want a pill and hospitalizations to “fix” them?  Are providers to blame for not explaining what is going on, and now appropriately answering questions?  What role does technology play–does anyone else experience patients telling them “I don’t know you should have it all in there <the computer>”.

I can’t understand it all.  In regards to a patients responsibility, I recognize that not every patient works in health care or understands what is going on.  Just as when I go to the mechanic I need guidance–however, when they tell me something is wrong with my car I ask questions to better understand or so I can at least try and find the best answer to the problem or just to grasp what is going on.  I do think that patients have some basic responsibilities. Have a medication list.  I understand that it’s difficult to remember a cumbersome list.  Carry one with you.  Ask your provider why you are taking medications if you don’t understand.  Know about your last hospitalizations and appointments and if your medications have changed.

Providers take the time to educate patients. In the hospital setting when I have a patient that tells me “I don’t know” in response to why they take a medication I try and help them understand.  I tell them they were hospitalized last because their heart wasn’t working correctly.  It doesn’t have to be a half an hour conversation–because most of us don’t have time for that–but just try.  We ask it of our patients so even if it is just explaining 1 or 2 medications– do it.

I think that technology is an incredibly cumbersome issue in health care and that it has a lot of positives, but also a lot of negatives.  We have become very dependent on technology to provide us with information about patients–myself included.  But has the fact that we find all of our patients information for them enable them not to know their own histories and medications?

To everyone out there, be informed and be informative. Remember how lost you feel at the mechanic or trying to fix your computer–that is how our patients feel.  To our patients: ask questions, read the information pamphlets we print for you, take notes.  Whatever it takes to help you remember and understand, do it.  I’m not pointing fingers anywhere, I’m simply suggesting a shared responsibility.

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