Patient Patient.

I was so fed up iwth my patient's relative today. What happen is, i
was going to clerk this patient and that patient agree to be clerk by
me. Patient autonomyis my first priority. However, suddenly this one
relative (maybe the son of that patient) suddenly acting clever and
tell me " If you want to ask questions, ask the doctor, not the
patient, can you see this patient is sick, why must you ask
question?".

Fair enough, i don't want to start a fight, we are professional, thus
i had to leave that patient but more spesifically the relative. The
wife of that patient already agree with me, and the patient also. I
guess patient autonomy does not apply for their relatives.

Fair enough, we still need to respect our patient, and we need to obey
them. if they refuse their medication also no problem nowadays because
patient have their autonomy.

What i want to highlight here is regarding 'asking question' or in
medicine it is called history taking. We could not say in malay "
ambil sejarah" because everyone will be blurred with that term.

History taking is one superior tool in making diagnosis in medicine.
Layman would picture doctor to read x-ray, holding stethoscope,
holding needle, and handle sophisticated modern machine to diagnose a
disease. However that is not the most important tool in medicine.
History of the patient is much more important.

More often drama and tv shows are showing doctors like house and
Grey's anatomy doing boombastic medical procedure to diagnose their
patient but to tell the truth, the part where they took history was
cut and they only show important question asked by them. So it would
not be boring.

In reality, we are spending at least 20 minutes to talk to the patient
and to ask them everything regarding their problem.

This is the first sentence that i heard when i enter medical school.

"80% of the diagnosis are made from history taking".

So asking question to patient is so important until all medical
doctors, i am sure, from everywhere in the world, they would need to
prepare themselves to be good in taking history before they can become
a good doctors.

However, most of patient and their relatives, did not understand that
history taking is used to diagnose patient. They think doctor just ask
question and talk with them without any purpose. I remember a friend
telling me that he read in the newspaper regarding a complain from
someone who complained that a doctor was insulting her father because
that doctor asked about her father occupation. She said that her
father was obviously poor by the way he dress thus why that doctor
need to ask about occupation some more.

It was a blunt with no guide complain. Occupation (social history) is
so important so that you are not only looking to the financial status
but more on to look what actually patient do in their work. poor man
can be sitting in the street begging for money, and poor man can also
work by lifting 200 pounds of wood on his shoulder everyday. If both
of this poor man present with inguinal hernia. is it the beggar or the
heavy lifter would be predispose to recurrent after treatment?

Doctors are looking beyond the scope of the disease. We take care of
patient not only in hospital but after discharged. Where the patient
would go, are the patient to continue his old job.. everything.

So, i hope that people would understand that asking question is
important in diagnosing a problem. It is common sense.

Doctors are people who want to knoe and solve the problem. So they
asked question. And they need to know.

p/s: A long time ago. when i was in secondary school. a friend tell me
a story about his grandfather. the story goes like this.

His grandfather would not talk a single word when he came to see a
doctor. When the doctor ask what is his problem, he would scold the
doctor by saying " you are the doctor, then you are the one who need
to tell me what is my problem!".

that time, i believed that that old man is right. But time change as
we became wise, now i would clearly and firmly said that he is totally
wrong. Doctor would not know wnything if you did not tell. History
taking contribute 80% of your diagnosis. Thus, if you did not tell,
doctor can only make it 20% or less. Tomorrow you will end up with
more catastrophic consequences.