SILENCE PLEASE

You want to be a good patient,no? No I am quite serious.You deserve the best care,the maximum output for your money you are dolling out to that white coater.So you better listen to this old man.Can you give me 15 minutes of your ear? O.k,then take out the pearls from the sand.You deserve it.
1.Before you enter the consulting room,set aside 15 minutes for composing what you are going to spill out to that idiot regarding your so called disease or ill health,I mean the history proper which means your symptoms,on the basis of which hangs his diagnosis 7 out of 10 times,so better watch out what you are going to sing out.take three deep breaths and find out the main or core symptom which has brought you to his consulting room.Wait a minute,you have decided no? Now recollect since when you started having the same,1 hr,12 hrs,3 days or 3 months or 30 yrs as you please. Now ,come out with the nature or severity and the periodicity,meaning whether it is continuous or intermittent,how much time it lasts,the symptom free period in between and the exact location,be specific.Now comes the turn of associated symptoms accompanying the main dish,the nature,when and periodicity and where ,I mean the location of the affliction.Now that you are in your 2nd gear,you can spill out the precipitating and aggravating factors contributing to the same.
2.You can enlighten him about your past history of any similar affliction and also your known previous diseases like diabetes,b.p,tuberculosis,trauma or allergies.
3.Don’t waste your time about which all doctors u have consulted and what all nonsense he has come out with especially his diagnosis of your paranoia.If u have any prescriptions or details of investigations you can submit the same with out your comments.don’t dump the laundry of the previous physician over to the next one.
Now that you have sufficiently confused the poor fellow,leave him to rest.Never exaggerate your symptoms to get his sympathy or down play to show how cool you are. If you have any family history of similar disease, it may help him.Regarding the symptoms,don’t come out with standard terminologies which others use with out knowing what they are talking about.So let him know what exactly you feel. Never use medical terms to show off your knowledge nor give an impression of being a fool as well.Always remember that you are giving him vital clues to your disease and that certain things which you feel irrelevant may prove too costly in the end.
A classical example of a precise history was a young man who complained to me that since 1 week he was having an abrupt dimness of vision of his one eye as if a drop of water in plane of his vision,the diagnosis was over after that simple sentence and what was left off for me was to confirm my diagnosis by few tests.it can be as simple as that.
He may give you maximum of 5 to 10 minutes for your history,so be precise,and convey maximum information after which he will cross examine you for the data he needs. To know when to stop your rantings.note when he yawns or interrupts you with a counter question.
For eg. Most of the patients who attend my clinic will complain of head ache for some time,unable to read,some doctor has given specs 10 yrs back,I visited many doctors,so many prescriptions,no use.It takes me 15 minutes of cross examinations to know that the patient has a head ache for the last 5 years getting worse,recurring type with a periodicity of 3 to 4 times a month lasting for 4 to 6 hrs or until sleep. He gets the eye strain only during the days of attack and is associated with vomiting or nausea and also that his head ache worsens with loud noises and he prefers to lie in a dark room and also that the head ache is precipitated by travelling in a bus or after a cinema and that the specs prescriptions has not helped him.Now even before examining him I know that he has a migranous type of head ahe and his eyes are not the culprit.Now I can proceed with my clinical examination.This patient had not given any useful information and I had to waste 15 minutes and there are 20 similar patients waiting out side,how do you expect me to be calm and cool and smiling ALWAYS?