Tuesday, November 29, 2011

Listen to your patients

"Listen to your patient, he is telling you the diagnosis" -Sir William Osler

Over my past 2.5 years of medical school, I have heard this quote over and over again.  It is mostly used in stressing the importance of taking a complete and detailed history.  It is used to say that the patient will relay the pathological signs as puzzle pieces, pieces that even a low level clinician can put together.  Think about the big wood toddler puzzles where there is no way a piece can be places in the right place.

My surgery attending, an old seasoned veteran surgeon, has recited this quote every time a patient comes in with mid-epigastric pain that radiates to the shoulder and is accompanied by years of "reflux" pain that is non-responsive to medication.  The patient may not use those exact words or explain it in text book order, but the patient is painting a clear picture of gallbladder issues.

I was recently reminded that listening to the patient can work the other way too.  Patients who come in with complex, in-congruent, complaints.  Patients who have pathology that clearly did not read the textbook.  These are the patients who are negative for every horse and most zebras, the patients who end up with diagnoses of exclusion.  The amazing part though?  We as providers approach the patient totally defeated, as if we have only apologies to offer, and they respond with complete affirmation and relief, as if they have known this to be true all along.  Their shoulders sink down, their spine uncurls, and they relax for the first time in a long time.  Then, when empowered, the patient begins to tell stories about why they expected this diagnosis long ago or how this diagnosis explains so many seemingly trivial signs they didn't mention before.

It amazes me how many different ways there are for a patient to tell you the diagnosis.  We just need to learn all the different, and subtle, ways to listen.

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