The doctor’s consultation

In this episode of talks, I am going to attempt to tell my readers how doctors think and how we arrive at our diagnosis. Most patients would be surprised to know that most doctors start examining their patients the moment they enter the consultation room. We have in our minds a method to our madness.{{more}} There are four basic parts of your interaction with your doctor. First, the doctor gets information from the patient by listening and talking with the patient. This is called the interview or history. He then looks at his patient in the form of an examination called the physical or clinical examination, after which he comes to a conclusion as to the patient’s diagnosis and then plans, with the patient, a strategy for dealing with the patient’s problems.

1. The interview or history: this is where the doctor says “Good morning Mr. or Mrs. A, how may I help you?”. Some patients do not wait for this and start talking; others cannot talk because of problems they might have. Whether or not you attend the doctor as an emergency, you should expect an interview. The doctor must talk to you and you should have a reasonable sense that you have had the time to tell the doctor your problem. The more information you give to your doctor, the more able he or she is to diagnose your problem. Do not trust any doctor who does not talk to you! Any doctor who starts to write a prescription before listening to you and asking some basic questions should not be trusted, even if it is the simple cold or flu. Let’s say you go to the doctor with what you think is the “flu” and all you need is some antibiotics and painkillers and a sick leave certificate. You go to the doctor and say, “Doc, I think I have the flu and I need some time off”. He gives you some painkillers, some antibiotics and a sick leave certificate and charges you $50 for the visit. Five minutes later, you leave with what you came for, but is it safe? How do you know it’s not something apart from the flu? Do you know that there are about 25 common diseases that can present with the “flu”?

Asking you a few questions like how long you have had it, do you have any fever, muscle aches and pain? Do you have dark urine or headaches, can help to differentiate between some of these diseases. There is also a difference in people’s mind as to what is the “flu”. Some think it’s a sore throat, others thinks it’s fever, aches and pain and still others think it associated with a cough and sore throat. There is also a difference between how men and women approach doctors. Men come with preconceived ideas and they know what they want; women, on the contrary, usually come wanting help and ready to share information. They will usually volunteer the information.

So, the initial questioning helps to differentiate what they mean. When patients come to me and say “Doc, I think I have a urinary infection”, my next question is “what do you mean by a urine infection?” To the patients, it may seem redundant, as they think I should know what they mean; but as doctors we want the “raw” unbiased (not the diagnosis given by another doctor) information. We want information on what you are actually experiencing. The doctor should ask about the about burning on passing urine, going very often, ability to hold the urine, blood in the urine, belly pain and fever. Questioning like this takes less than a minute and is part of the “art” of medicine. Specific, pointed questioning like this also takes knowledge and experience. Being a good doctor is like wine; it gets better as it ages! Next week we will explore what else your doctor should ask you before he or she touches you.

For comments or question contact:

Dr. Rohan Deshong

Tel: (784) 456-2785

email: deshong@vincysurf.com