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