The patient history, demystified

In the first six months of my intern year, I gained some valuable insights into the patient history. Medical students, wow your attendings by translating these common patient phrases into their actual medical meanings!


Things that don’t mean what you think they mean:

“I have thyroid problems” –> I’ve gained weight recently

Follow-up questions: What medication do you take for that? When was your thyroid checked last?

“I have endometriosis” –> I have painful periods. I may or may not have ever been formally evaluated for or diagnosed with endometriosis.

“I had a partial hysterectomy” –> Someone took something out of my pelvis, I’m not sure what. I may or may not still have tubes, ovaries,  and a cervix.

Follow-up questions: Did you have hot flashes after the surgery? Have you been taking replacement hormones? (Hint: If they were pre-menopasual before surgery and they didn’t have menopausal symptoms immediately after surgery, they probably still have at least one ovary.)

“I got a Pap smear last month.” –> I had a pelvic exam.

“I have never had surgery.” –> I have had three c-sections and a D&C, but I don’t think of those as surgeries.

“I get migraines” –> I get headaches.

Follow-up questions: What medicine do you take for these headaches? (Hint: If they say the headache usually goes away after one tablet of Tylenol, it’s probably not a migraine.)

“I have the sugars” –> I’m diabetic.

“My blood is low” –> I’m anemic.

“I take the blue one in the morning.” –> I have no idea what I’m taking but if you’re lucky I brought the bottles.

 

Things people never admit to:

Herpes. Ask, “Have you ever had any sores on your genitals? Have you ever taken a medication called acyclovir?”

True story: I had a pregnant patient who swore she had no past medical history. Her chart said she was allergic to acyclovir. I asked her how that came to light, and she said “Well, sometimes I get these blisters down there, and my doctor did some sort of test and then she gave me the acyclovir, but it made me sick to my stomach.”

Polycystic ovarian syndrome (PCOS). Ask, “Do you have any trouble with unwanted hair growth on your chin or upper lip? Any acne? Do you ever skip periods?”

Irregular periods in general. Ask, “What is the longest you have gone without a period in the last year? Do you ever have more than one period in a month?”

True story: I recently saw a 24 year old patient who hadn’t had a period in 3 years. She had seen multiple physicians in that time but never mentioned it to anyone, even the gynecologist treating her for pelvic pain. 

Erectile dysfunction. No idea, ask a urologist how to get them to fess up.

True story: As a student, I knew if a patient was having erectile dysfunction because they were the only patients who ever asked me to leave the room. 

 

I know I’m only scratching the surface here. What crazy things do your patients tell you?

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