Patient history - focus on the patient

A medical student learns that good outcomes for patients can depend on more than just scientific diagnosis.

'Throughout medical school, we’ve been taught about the importance of taking a full history in order to gather enough detail to be able to make differential diagnoses. Starting placement, I used to really concentrate on this framework, focusing on getting all the answers to questions rather than focusing on the answers themselves.

During a consultation with a patient, I started to take a social history when I noticed a slight change in their facial expression and tone of voice (they became quite blank, paused and spoke very quietly). Although there was nothing mentioned in the patient’s notes regarding any social concerns, they appeared slightly troubled; I forgot about the rest of my social history and decided to concentrate on this area by asking the patient if they were okay and if they wanted to tell us anything else. With this, the patient suddenly broke into tears and explained the reasons for their current stress.

It was my first time witnessing a patient cry, so I felt quite taken aback. It was upsetting to hear about the patient’s troubles, but the experience has highlighted the importance of focusing on the patient themselves and not just the history they are giving. It has taught me not to overlook certain aspects of a history, and to really listen to what the patient is saying. By shifting my focus to the patient’s distress and acknowledging their concerns, I was able to provide relief to the patient as well as an action plan to discharge them much sooner than was planned.'