I’ve been having the same interaction in the ED, day in and night out, since I began:
me: Hello, I’m GruntDoc, what is the problem today?
I feel bad.
me: okay, what does that mean to you? Do you have pain?
pt: uh, well, I uh, it started a while ago, and now it’s not better…
What follows is usually a long question and answer session to clarify the problems, timing, etc. (I keep reading that if we just let patients talk they’ll tell us what’s wrong with them. I tried that one day, I really did, and I either got very long, strange silences or a literally 5 minute long monologue that went nowhere. Maybe that works in office-based practice, but it doesn’t often work in the ED).
Please understand I’m not making fun of patients, what I’m trying to point out is that patients present without actually thinking about how to describe their problem(s). (There’s the exception, and they’re rare, and usually complicated). So, I wonder if a little social engineering might be in order (and that may be the wrong term).
What I’d like to try (has it been tried?) is putting up a sign that says ‘you may be asked the following questions’ in each room, the waiting room, etc. In that way the patient could be assembling their thoughts into a more usable and understandable fashion. This would have (I hope) the following happy outcomes:
- a quicker, more usable history
- more inclusion of patient history, pertient facts
- not missing important history because they didn’t remember for 2 hours, etc.
I think having better histories would do more for patient safety than all the medication reconciliation forms in the world. Has this been tried? I think it’d work, but maybe I’m kidding myself.