October 24, 2015

Can Patients Learn to Describe Symptoms Better?

While this is addressed to other physicians at the annual meeting of the Society to Improve Diagnosis in Medicine, maybe it should be asked of patients. John Ely, MD, MPH, a family physician who is retired from the University of Iowa in Iowa City, has been a patient himself recently. He got to thinking about what a good patient could do. One of the things professors teach medical students is the eight characteristics of a symptom.

Dr. Ely wants patients to learn these to be able to communicate their symptoms clearly to aid doctors in making an accurate diagnosis.

"Dr. Ely listed these eight characteristics:
  1. Where is your pain or numbness? This obviously wouldn't work for more generalized symptoms like fatigue or shortness of breath.
  2. How long have you had the symptom? If it's something intermittent -- like a spell of chest pain -- how often does it happen and how long does it last? Is it gradually getting worse? Getting better? Staying the same?
  3. What were you doing when you first noticed the symptom? Were you just sitting there? Arguing with someone? This is particularly important if the patient is having dizziness.
  4. Are any other symptoms associated with this one -- for example, light-headedness or shortness of breath?
  5. What is the "quality" of the symptom -- what does it feel like? "Patients sometimes say to me, 'What do you mean? It's just a pain, doc.' Well, is it like an elephant stepping on your chest, a fire in your chest, someone stabbing you with an ice pick, or what? I want to stay open-ended as long as possible, so [I usually say] 'Just tell me ... what it feels like,'" said Ely.
  6. What is the "quantity" of the symptom -- for example, how bad is it on a scale of 1 to 10?
  7. What aggravates the symptom?
  8. What alleviates the symptom?"
Physicians want to know a patient's chief complaint, "and then we want a paragraph -- not six paragraphs and not a novel -- and in that paragraph you need to tell the doctor these eight things," Dr. Ely said.

If we could learn these characteristics, we could increase the productivity of our visits to the doctor. However, many patients will refuse to do even this.

Reasons patients refuse:
  1. Insist on being a drama king or queen (happens too often)
  2. Feel that they should depend on the doctor (want the doctor to ask questions)
  3. Want to stump the doctor (these patients have heard about something on the TV and think they should be taking that medication – typical hypochondriac)
I could probably list more, but those are the three I have heard while sitting in the exam room waiting for the doctor. You can really be entertained through the walls sometimes.

1 comment:

Jane said...

Good topic Bob. Gives me something to strive for in preparing to meet my g.p. and my physical therapist.