Comments on: The waning art of history taking

By: MHA

MHA — Sat, 10 May 2008 19:30:46 +0000

ck is exactly right; in my first year we had to take turns taking a history on a standardized patient in front of a small group of our classmates a month or so into school. We were supposed to memorize the exact order (CC, HPI, PMH, etc.,) and where each piece of information was supposed to go (smoking goes in social hx, cousin Frank’s dilated cardiomyopathy – what was that, again? goes in family hx, etc.) even though we had had exactly one lecture on taking a hx and none of us had ever taken one. We weren’t allowed to take a progess note into the room with us, either. Like so much of clinical medicine in the first two years, we were supposed to just “receive” it like magic, I guess…

By: Joan H

Joan H — Thu, 08 May 2008 00:11:15 +0000

Having had rheumatoid arthritis for 31 years (just to denote that I am practically a “professional” patient) I feel
the opposite on this nurse vs. doctor thing. I rarely feel
confident enough in the office/clinical nurse and just
humor them through the ritual ROS so that I can finally
have access to the dr. to discuss a problem. Although it
would be ideal to feel confidence in both professionals
I would way rather have the doctor be on the ball than
feel that the nurse was the one that would “represent” me.

By: SarahW

SarahW — Wed, 07 May 2008 22:22:11 +0000

Solution: Read the intake notes? Seems to me that a thorough, forget clever, diagnostician would catch on.

By: anonymous

anonymous — Wed, 07 May 2008 10:17:43 +0000

i don’t think disagree that nurses can elicit things that doctors don’t, but frequently the nurses have more direct contact with the patients, allowing them time. i totally disagree that it is apporpriate for her to hide information in notes that she realizes they are not being read. way to go team! is there anyone else who thinks that is a conducive to good delivery of care?

By: Patrick B

Patrick B — Mon, 05 May 2008 23:25:25 +0000

Wow, Holly, a bit much on the hostility front! I actually agree with “Da Goddess” (it is a bit of an healthy-ego name, but who am I to talk about ego…). I don’t think she was saying that she is better than an MD, but rather that she brings something else to the table. I think she has a point that some patients will open up more to a nurse–doctors can be intimidating (you intimidate me, and I’m a fellow MD!) and patients don’t want to say something that they believe may disappoint their physician. Also, some doctors can seem a bit judgmental (ahem).

DB–If I may ask, what was the mystery book? I’m always looking for a good audiobook, and if it can help me take better histories, all the better!

By: Holly

Holly — Mon, 05 May 2008 21:33:57 +0000

To “Da Goddess” nurse [the screen name says a lot about your ego. Sorry Madam, Ego, RN]

What a surprise!… Another nurse, previously ‘a medical assistant’ feeling the urge to tell the world that nurses know better –more than MDs, are able to communicate better than them, yadda, yadda…
Thank you to “Da Goddess, RN” we all have learned that when having a stroke, a heart attack, cancer, etc. we must immediately summon a nurse [even better, a nurse who previously was a 'Medical Assistant'] for the best treatment and ultimate return to great health –not a trained physician, mind you…
Get a grip on reality, you fool!!!

Holly M. Wagner, M.D.

By: Da Goddess

Da Goddess — Mon, 05 May 2008 20:51:00 +0000

As a nurse, and previously as a medical assistant, I’d often extract major clues from patients on intake forms simply because I wasn’t “The Doctor”. Sadly, many doctors would fail to read my notes and then be surprised later, while they were scratching their heads and digging through books, when I’d point out to them what the patients told me. It would please me to no end when I’d get medical students (or that rare totally thorough doc) at the hospital who’d actually read through ALL my notes and pick up on the clues strewn about.

Just as it’s essential for docs to get a history, so too is it important that nurses glean as much information from our patients. Nurses aren’t nearly as intimidating and can often approach patients in a more conversational manner that elicits much more candid responses.

By: ck

ck — Mon, 05 May 2008 20:07:24 +0000

Ugh. I remember my 1st year standardized patient examinations — we had to memorize a full history and ROS and what to do on a full physical while having absolutely no concept what the point of it all was. This is all so the school can say you get “simulated patient exposure” during year 1. What a waste.

Student 1:”Hey what is the JVD supposed to show?”
Student 2:”I have no clue. I just know you lean them back on the table, look at the neck, pull out a ruler and say “the JVD appears to be 7 or 8 cm”. Oh, and you have to look at it kinda sideways…something about transverse lighting and shadows.”