Taking a History.

     In my opinion the single most important element in any patients evaluation is their history. This applies to accident victims where the EMT's and Paramedics must determine with rapidity and accuracy just what happened to a patient at the scene of an illness or accident. As well as any significant allergies or medical problems from family or friends if the patients cannot speak. If multiple victims they need to know where they together in the same vehicle or place or does it just appear that way. Just as in law enforcement circumstances can be very misleading.
     There are many other examples of accurate history taking I could give but the points are the same.
1.  What is the patients medical history?
2.  What are their current medications? and have they recently stopped any medications?
3.  What medical procedure, surgeries,treatments, accidents have they had in the past?
4.   What is their family history? does it relate to their current illness or complaint?
5.   Is their a history of drug, alcohol,tobacco use?
6.   The list could go on but you get the idea.

     Now maybe the most important one. What are they reporting as their main problem or complaint?
This is where I see so many mistakes made in the evaluation of a patient. Sometimes we come to a conclusion too quickly due to input from family or other heath providors. Or maybe we forget or are too rushed to ask a few more questions.One more question might allow the patient to open up and share what is really on their mind. Sometimes i think they want to see how interested we are in them and their problem. If we rush them in and out they lose their respect for us or assume they are not really important. Sometimes the patient does not even give us all the information they could because they are afraid of the outcome or their family members don't know that many of their symptoms have been going on for some time.

     Each situation and patient is a unique case and must be handled that way.  When we sign off on the evaluation as a EMT, medical assistant, physical therapist,respiratory therapist,nurse,nurse practitioner,physician assistant, physician, or consultant we have essentially passed the patient on to the next level of care.We must make sure we have done the job to the best of our ability and training. If we do not then we risk harming that patient and changing the outcome of their treatment. Sometimes in a way that can change that patients life forever.

     I hear all to often of incomplete workups blamed on this or that factor that result in the patient being misdiagnosed and suffering needlessly. Many patients will go to the doctor once for a problem(especially men) and if they are told it is nothing serious they may not return until it is too late. The reason for this is because "the doctor told me there was nothing wrong with me." Many patients put way too much confidence in one doctor and don't know to seek second opinions when symptoms persist or increase.

    We all need to do our jobs to the best of our ability even with the most difficult patients. Sometimes those patients are actually hiding behind their behavior. I like to think of them as my biggest challenge and never take their problems for granted or dismiss any new symptoms they are telling me about as just more attention seeking behavior until i have fully evaluated them to 'MY' satisfaction.

    To make an analogy to a car: If you take your car to the mechanic and try to describe to him what the problem is you want him to find the problem and fix it if possible as soon as possible so it wont cost you more or do more damage later if not properly taken care of now!!!! Everyone can relate to that. Patients are no different than a car really except that they can talk and try to mislead us or lie to us about heir history or symptoms. That is what makes the job as a health care provider so interesting. It really is alot like being a detective, and your job is to get as much evidence as possible to catch the culprit that is making them sick!!!!

                     Joke for the Day:  Why did the watch go on vacation?
                                                         (to unwind!!!!!!!!!!!)