Doctors must be adept at "20 Questions"

Commentary. By Eric Anderson, MD, AMNews contributor. Nov. 11, 2002.

COMMENTARY

Observations on the state of medical practice and medical life

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We have a lot of questions to consider when we first meet a new patient.

There's important stuff like: Is this the worst headache you've ever had? Have you had any trouble with vision? Does that black mole ever itch? Could you be pregnant? We wouldn't want to miss a patient with physical things like a subarachnoid hemorrhage or temporal arteritis or malignant melanoma or ectopic pregnancy.

Then there are more subtle considerations, our probing to understand the human mind. Is your energy level as good as it used to be? How are things at work and at home? Are you winning? Do you have any spiritual problems? Do you feel life is worth living? We all have to remember depression is the missed diagnosis.

Then there are the logistical inquiries. Are your immunizations up to date? Have you had any recent medical attention? Did you move here for health reasons? Are you taking your medicine exactly as prescribed? Did anyone come with you today? Do you have a relative, friend or neighbor who could help you with this problem? Did you have any difficulties with previous doctors? Has anyone in your family ever had this illness? Do you have a particular fear or concern? Is there anything we haven't covered? And it would be tempting to add -- Do you have any lawyers in your family?

And since emotional problems are so common and sometimes difficult to uncover, we have to dig deeper: Do you have these symptoms every day of your life? Are your symptoms any different on weekends or on vacations? Why did you come today with this problem you've had for so long -- what has changed? And the scary question that sometimes tempts fate with the answer "Never": When did you last feel perfectly well? [...]