History-taking is vital in medical practice. It translates a narrative using clinical knowledge acquired over many years of training in a systemic art form, to analyse symptoms and form a diagnosis. It is one essential skill that differentiates a doctor from a google search.
A doctor knows what questions to ask next, taking the patient's full circumstance into perspective.
Thanks to hot knowledge and the internet, I find a lot more people presenting with diagnoses rather than symptoms. This can be misleading for the doctor and they have to work backwards to prove or disprove the theory.
Some patients, having analysed their symptoms online, will maintain a streamlined presentation of symptoms to lead a doctor towards the diagnosis they have decided. This can be detrimental. I will share some examples another time.
Today, it is my dearly beloved reception staff who have decided to make my job easier by diagnosing the patient at booking.
He is a 90 year old man. Booking notes: "Depression. Since his wife died recently, he has not been eating and is losing weight."
I set my mood and called for him on the buzzer. A spritely man swung the door open, did a little jig then waltzed unto the patient chair.
I looked at the booking notes again to be sure I had the right patient as it seemed completely incongruous with the man sat in front of me.
"Hello Mr. Jiggy. " I said with a smile, confirming his identity and wondering if I had actually misread his actions. Perhaps he was staggering drunk from drowning his grief, but no, he was collected and smelled fresh.
"How are you?" I asked cautiously, stressing on the "are" to emphasize my concern for his wellbeing.
"Oh, I'm feeling Chucklarious." He said and then giggled at his own clever spontaneous joke. "Do you get it, chuckle, hilarious, chucklarious?"
I looked at the booking notes and back at him again.
"I'm so sorry to hear about your wife" I started
"Aah," he said and waved his hand in the air dismissively. "That one, she was a bad woman. Terrible, terrible woman."
I sat back in my chair. Better let him take the lead on this one, I thought.
He then told me the sad story of how his late wife, who had been his second wife, had transferred all the money in their account, which was most of his life savings, to her son from a previous marriage just before she died. "Twenty years of my life wasted on that godforsaken woman." He said.
"I should have known she was up to something when she asked me to marry her. That was a red flag!" He said "My first wife did the same and it did not end very well either."
The conversation went into his historical love life, complex family dynamics, his time in the war and so on.
We talk about marriage proposal traditions. Me mostly uhm-ing and saying " well" to most of his opinions.
My head was still waiting to get to the bereavement and grief part where he was not eating and eventually, he did.
"So you see, the problem is, I have not had to cook for myself in seventy years and don't know where to start now. My daughter (who lives in Australia) suggests I buy one of these air fryer things. What do you think doc, are they any good?"
We talk about air fryers.
"Well actually, what I would like is to meet a nice woman who can cook." I suggest simple air fryer recipes and options like Meals-on-wheels and home delivery food services. "well yeah, I guess," he says turning his head form one side to the other in contradictory movement. "But I'd prefer to meet a woman, they're other things you can do with a woman."
Err, okay. I'm not ageist, I concur but spare me the details please.
We talk about various places he can go to find love. He has tried the pub, too many men there. He has tried the community centre but they mostly did things like knitting and line-dancing - too boring for him. He was considering going online but he didn't trust that.
I agreed to refer him to the befriending service and see what other suggestions they may have.
He was a charming pleasant man and my last patient for the day so I had allowed the conversation run longer than usual.
After a while, Mr Jiggy sits back in the chair and looks at me with a smile on his face.
"So," he says. "Do you know how to cook?"
Ps: Who is to argue that some Jollof rice is not a cure for Depression 😄🤯🤓