A good strategy I’ll try this sometime. I’ve don’t do much teaching these days as I am 100% clinical, and adding a student from our affiliated med school would be just more unpaid work on top of a day’s already unmanageable work load in primary care. But I digress from your thought provoking topic here...
I really love narrative medicine, and I use this intensely, mostly eschewing the EMR templates that chop narratives into incohesive checkboxes. But I have also learned the dangers in following a patient’s story too closely, and being led astray from the diagnosis
Have you ever tried just focusing on the chief complaint? For example I might listen intently to a long and nuanced story, but once I hear chest pain, I add that to the visit problem list. I’ll do a standard chest pain work up, explaining that while I was listening to the fact that it seems worse when the weather is cloudy, in parallel we have to rule out prime suspects in order of catastrophic to mundane.
The art is appreciating at once our patients’ complex stories AND their underlying architectural symptom-based simplicity.
Usually the patient ends up being right with their hunch, but often denial and rationalization and good story telling can be dangerous, too.
In terms of reverse history taking presented here, I think it’s another valuable way to break stories apart before we put them back together in diagnostic and therapeutic ways
My high school geometry teacher taught us to do our proofs backwards too. Interesting article. Thanks
A reader emailed me to say that in the military, this is called “bottom line up front.”
Makes sense!
A good strategy I’ll try this sometime. I’ve don’t do much teaching these days as I am 100% clinical, and adding a student from our affiliated med school would be just more unpaid work on top of a day’s already unmanageable work load in primary care. But I digress from your thought provoking topic here...
I really love narrative medicine, and I use this intensely, mostly eschewing the EMR templates that chop narratives into incohesive checkboxes. But I have also learned the dangers in following a patient’s story too closely, and being led astray from the diagnosis
Have you ever tried just focusing on the chief complaint? For example I might listen intently to a long and nuanced story, but once I hear chest pain, I add that to the visit problem list. I’ll do a standard chest pain work up, explaining that while I was listening to the fact that it seems worse when the weather is cloudy, in parallel we have to rule out prime suspects in order of catastrophic to mundane.
The art is appreciating at once our patients’ complex stories AND their underlying architectural symptom-based simplicity.
Usually the patient ends up being right with their hunch, but often denial and rationalization and good story telling can be dangerous, too.
In terms of reverse history taking presented here, I think it’s another valuable way to break stories apart before we put them back together in diagnostic and therapeutic ways