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Dr. Rishi Desai here from Osmosis.
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and I'm going to talk to you today about three tips
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to taking a really good patient history
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really important stuff.
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My advice to you again is, of course, you know how to get a patient history.
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the mechanics of it are pretty straightforward in the sense of you have a chief complaint,
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a main issue that they are therefore sometimes called presenting complaint.
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And then you have that HPI, the History of Present Illness.
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You have the past medical history,
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the medications and allergies, family history,
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social history, all that kind of stuff, review of systems
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that's the mechanics of it.
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But my tips on how to do a good job getting it.
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That's what we're here for.
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So let's start with my first tip,
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which is listen well and empathize.
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So keep in mind.
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The person is coming to you,
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They could go to a robot and then they can get all these questions answered.
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like, how long has the pain been there? where does it radiate to?
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All that stuff a robot can tell them or surveys that could fill out themselves.
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The point of you being there, a human being is to empathize to listen.
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They're there because they're scared, they're in pain often times and uncomfortable,
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something's going on they don't understand and they have a problem,
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and any time you're trying to extract a problem from a person
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you do that by listening with your whole body,
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meaning active listening, so kind of sit up straight.
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Make sure there's nothing blocking you from the person you're speaking to,
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maybe even lean in a bit, show concern on your face,
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show with your eyes, show with your body language
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and make sure that you are locked in
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because they're locked into this conversation.
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if you're kind of off, typing your note, you're thinking of someone else,
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you are not going to be locked in, and they may not tell you important details,
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so make sure you're completely locked in to the patient
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and that you're focused on them when you're trying to extract this information.
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So the idea is, you want to make sure that they feel comfortable telling their story to you.
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Keep the questions to a minimum, and this is important.
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You don't want to keep peppering them with,
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and then how many days did it last for,
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and then tell me exactly when it started and when it stopped and what were the triggers
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and let them tell their story naturally, you know, people don't like to be interrupted in
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what would happen is you think you're doing a great job of staying on track and watching your clock.
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But actually, what happens is that they may not tell you important details
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because they think this guy is too busy, or this guy is being kind of a jerk,
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just kind of pushing me along.
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So let them tell their story naturally,
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and then use your questions really kind of guidingly.
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Use Open ended questions not closed questions.
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Allow them to kind of tell you as much of their story is possible and again empathize.
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that's the first tip: empathize as much as you can.
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And now the second tip to getting a good story is make sure you reflect back and summarize.
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So empathize and then summarize, say, "so this is kind of what I'm hearing.
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This is what I think you're telling me. Is that right? Am I missing anything?"
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And you want to make sure you do it not just around what they're saying,
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but also around the data.
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So this is something very few medical students or residents do in my experience.
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they may not go over the patient data with the patient
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and where we're entering a world with that more and more important.
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So I like to go over the X ray over the imaging in the in the data.
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Make sure you know why it's happening if you go over so that the patient knows why it's happening,
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Say, Hey, look, this is what we have. We have a CT scan that shows calcifications in the brain.
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This is what we think that means,
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we also see sodium level of X or potassium level of Y,
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this is kind of how I'm putting this together,
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and this is how I'm summarizing it. Is that kind of you know what you think too?
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make sure you are on the same page?
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Third tip is what I like to call ice.
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I, C, E, so it's an acronym.
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And ICE stands for a kind of ideas, concerns, expectations.
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So what what are their ideas? What are their concerns? What are their expectations?
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This is actually something that I would say is kind of a top tier tip,
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because most people don't even get into this kind of thing,
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they don't ask, you know, so what do you think is going on?
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What are you concerned about?
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They just assume that what the physician is concerned about is what they should be concerned about.
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So this is a major misconception, and a chance for you to kind of separate yourself
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from again a robot or some sort of survey instrument.
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So a quick story here, I had a five or six-year-old, little kid, really sweet, and he had leukemia,
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and I was seeing this patient in his parents.
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And we're talking for a while about leukemia
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and I was thinking about kind of all things I was worried about
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bone marrow suppression and then your bleeding risk and infections, etc.
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And I said, you know what? What is he worried about?
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and I asked them, I said, what are you worried about?
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and his parents said the thing that he's really scared about is this summer.
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I was like what do you mean? Well, and I'm thinking again, You know chemo,
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but they said, no, no, no, it's not the chemotherapy, he's actually gone through around.
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He doesn't mind that at all. What he's worried about is his central line.
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He has a central line and it's on his chest.
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I'm just going to show you kind of on my chest
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and he's worried about swimming because that central line needs to be protected from the water.
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And so he's scared that he can't go to the beach, he can't go to a swim camp that he really loves,
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and that's what he's worried about,
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and I thought to myself: oh my gosh, are you kidding me?
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We can figure this out like we can do all this other stuff,
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but if you're worried about swim camp, we'll wrap that up,
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we'll put plastic on, we will make sure this kid gets to its own lessons.
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And he was overjoyed, he was so happy.
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You know that's what he was really freaked out about.
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He could care less about the leukemia, he knew he was going to conquer that with the meds,
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and he was going to get through that this fine,
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he was really worried about swimming,
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and so again what were his expectations,
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what were his parents' concerns or their ideas?
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And so those are the things I want to go through.
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kind of Ideas, Concerns, Expectations - that's the ICE acronym,
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and it really makes a huge difference.
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So again, tip one: empathize, listen carefully,
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and you might even extract pieces of that in your social history
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you know what do you do for fun? Oh swimming. Tell me more about that.
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Number 2, make sure you summarize,
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make sure you understand, have a shared understanding of what's going on.
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And number three: ICE. Make sure that you have a really clear sense of
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like what their ideas, concerns, expectations are.
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And so anyway, those are my three tips.
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It's made a world of difference in the many years that I've practiced medicine,
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and I hope that they help you as well.
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Again, like the video, make sure you share your comment,
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a specific comment about what you think makes for great history taking.
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And I'll see you later. Take care, guys.
