Broome Docs Podcast: the “difficult historian” rant
February 17, 2013
OK, welcome back to the podcast.
Apologies but this one is a bit of a disgruntled grumble about a few things that really annoy me in modern medicine.
I have just met my new cohort of JMOs, students and trainees and they seem like a really smart bunch. So I thought I would put this out there for all.
If you are a senior doc then you might appreciate it, and if you are on the way up – then here is some advice:
– Do not use the term “difficult historian”… EVER
– Dyscopia is not a diagnosis. It means you have not understood what is going on and have no plan for your patient.
Apologies for the dark tones. Back to fun and light next post. Promise! Direct download here
Casey, on the scale of rants this is a pretty mild-mannered one! I’ll agree with you on dyscopia or ‘acopia’ (and in fact we had one of these admitted to the ward this week. Drunk, as it not so surprisingly turned out.). I’m less sure about the ‘difficult historian’, or at least I will agree with you that ‘difficult historian’ is a bland, vague, non-contributory phrase.
However, I do think that making some kind of statement about the nature of the history-giving can be informative:
“This 46 year old man gives a clear history of excruciating pain radiating from the right loin to groin, lasting for ten to twenty minutes each time, which came on suddenly at 10am today and has recurred three times since then, associated with sweating, nausea and brown urine.”
“There is limited history available from this 46 year old man, possibly due to language difficulties, but as far as I can make out from him it appears he has been having abdominal pain for the last day or so. The rest of his past history, as gleaned from the notes and the ED staff who know him is as follows…”
So, as long as a broader picture is painted, then I think it’s helpful. ‘Difficult historian’ is certainly too vague and pejorative to be helpful, but we shouldn’t throw the baby out with the bathwater.
you dont like dyscopia or acopia terms…so do you accept ” social admission” as a term if presented to you as reason for presenting complaint?