Be truthful during the doctor’s interview!

Over the last two weeks, I have been exploring what doctors do in their offices. Specifically, I have been discussing the interview.{{more}} We are discussing your first visit to the doctor’s office. Most patients believe that the doctor should just “know” by looking or listening to them. They do not appreciate that the doctor needs to do both to come to a diagnosis. In most cases, a good interview or history is all that is needed to make a diagnosis. The doctor has to also have an “open mind” about your complaint, as one complaint may have more than one cause. So, patients who come with preconceived ideas (usually men!) and those who have visited previous doctors (older women) may pose problems for some doctors.

The part of the interview which elicits the most emotions in our society is the sexual history. This is because of all the social taboos surrounding sex. Gynecologists, general practitioners, urologists, surgeons and emergency room doctors usually ask these questions and usually for a reason. Questions like when was your last “normal” menstrual period; are you sexually active, faithful, and if not, how many partners; and whether you use condoms or not can help doctors diagnose otherwise strange symptoms, like the young lady whom I saw recently with lower limb pain, lower abdominal pain, irregular periods and some urinary problems. She had just started a new relationship and was worried about appendicitis. After a few more specific questions and a quick examination, I knew she did not have appendicitis, but instead pelvic inflammatory disease (PID). One blood test and 2 days later, I diagnosed chlamydial pelvic inflammatory disease and urethritis, hence contact tracing and treatment had to be pursued to reduce the risk of recurrent PID.

The above case demonstrates why doctors need to ask about the sexual history and patients need to be truthful. Married men generally try to impress about their faithfulness (as though I am their wife!) only to admit they have been unfaithful when the urinalysis or the blood test proves otherwise. Some men who insist on faithfulness cannot imagine that their wives may be unfaithful, so the sexual history has to be done very tactfully and, all too often, one partner or a minor will not volunteer the information in the presence of the other partner or a parent; so sometimes I have to ask the other partner or parent to leave the interview room temporarily. This does not go down too well with the person being asked to leave, but my first commitment is to my patient.

The next part of the interview is the social and family history. The social history includes things like the use of recreational drugs like alcohol, marijuana and cigarettes, including the amount, duration and frequency. The social history also includes things like occupation, income and support and family structure.

People have no problems enquiring about the family structure for children, but cannot understand why I insist on taking a detailed family history from older men who usually come alone to the office. They fail to realize once a man, twice a child! That is why older men (over 60) need to come to the doctor’s office with someone, as older men generally do not remember what you tell them when they leave the office. They usually return to the follow up visit not following instructions from the previous visit. They do not remember the diagnosis or the medications to be taken. They cannot remember what to do when the medications are finished and when to take the blood test. Besides, they come to the office alone without the medications they are taking and they do not remember the medications’ names.

They are also less mobile, take a longer time to get onto the bed, take off and put on their clothing. They also have more trouble paying the office bills and buying the medications. Hence, the reason I insist that older men bring someone with them. The other reason pertains to named next of kin. Doctors need to know who to call in times of trouble. Elderly patients can get confused and when it comes to informed consent for procedures, they should have someone else witnessing the informed consent. This person should be the next of kin. The next of kin should also be there when discussing treatment procedures, treatment options and medications. This next of kin should preferably be someone who lives in the same house, or nearby, and should be normally legally responsible.

For comments or question contact:

Dr. Rohan Deshong

Tel: (784) 456-2785

email: deshong@vincysurf.com