I have taken this sad truth as a fact of life: most patients that I interview have an incomplete idea of many crucial aspects of their health. They don’t know what tests have been done, what they are for, what medications they are on, what conditions they have… And the list goes on.
Take for example, several weeks ago I interviewed a relatively well educated and intellectually intact patient, and this is how it roughly went:
Me: sir, what medical conditions do you have?
Patient: nothing, I have been healthy.
Me, knowing any question worth asking once is worth asking twice: any medical problems in the past?
Me: ok… What about your heart?
Patient: oh yeah, I had a heart attack and almost died 5 years ago.
So I went through the rest of his body systems one by one to help him remember other things like heart attacks that are generally considered “past medical problems”.
Me: ok, sir, do you take any medications?
Me: nothing? No medications?
Me: what about the diabetes and high blood pressure you told me about?
Patient: oh yeah I take metformin, metoprolol, candesartan, aspirin, Lipitor…
Why did you say “no”? What did you think my question meant before? What if I was less patient or busier, and believed your answers when you so definitely gave them?
I don’t think the patients meant to do this on purpose. Usually it is simply miscommunication or something being lost in the language barrier. And sometimes we are at fault for asking unclear, ambiguous, or misleading questions.
But every so often, I can’t help but imagine a patient must be pulling a prank on me when I take a history. Maybe one day I will ask someone about their surgical history and they will say: “nothing, doc.” “And what’s this beeping in your chest?” “JUST KIDDING! I have a robotic heart! 😀 GOTCHA!!!”