Patient history - being present
In this example, a medical student learns the most important part of taking a full history is meaningful conversation.
'When I first started talking to patients, I spoke to them to ‘check’ all the boxes of a history. To make sure when I was asked a specific part of a history later when presenting, I would know each part. I wrote them down in the same order every time and, when patients digressed, I would ask questions to steer them back towards the structure I was used to. I did this as I thought it would make it better for my learning, to be able to get a quick succinct history.
While on placement, we had a teaching session with the registrar. To prepare for that session, the registrar asked me to go and take a full history from a patient. I thought, great, something I’ve had lots of practice doing, I can do this. But then the registrar said that I couldn’t write anything down until after I’d spoken to the patient.
This was a little nerve-wracking for me as I was worried I would not be able to remember everything about the patient. But I was surprised when, instead of becoming a list of presenting complaints, by ‘being present’ in the conversation my history was with a person. Instead of a list of random bits of information, each bit became easy to remember because it was part of the person.
Without writing things down, the conversation flowed more freely and the patient spoke more freely. I found out how a symptom of breathlessness was keeping the patient from their shopping, which was important as they were a carer for their partner and had never felt like this before. In one sentence, I had learnt so much, which in my previous method of taking a history would have taken me 3 or more questions to work out.
I then carried on with this method, only afterwards jotting down the details from the conversation. I learnt that patients, for the most part, are willing to give you all the information you need and more, and that they will often give you this information without even having to ask for it.
Not only has this way of taking a history improved my learning, being able to see the patient as a whole. This also improves rapport with the patient as it feels like a conversation rather than previously what I think must have felt like a ‘grilling’ for them.'