Basically I am a clinician which means that I treat patients. History taking is an important part of the clinical analysis of the patient. There was a time this was being done diligently - maybe history taking and clinical examinations were the only 2 skills available to the doctors then. Of course some simple blood and urine tests were possible and were being done if needed. This assured that adequate time was spent by the doctor with the patient giving scope for a good communication, observation and documentation which forms the basis of a good logical diagnosis. A correct diagnosis is essential for proper management of the patient and best results.
This brings us back to history taking - how important is it in this modern era of advanced technology? Is it not enough if a trained (not necessarily a doctor) person takes the data on a ticking basis saving time for the doctor? Sadly, NO. It is interesting to note that 80 - 90 per cent of the times the diagnosis is made by history and good clinical examination. All the new technology and the machines only help in refining further 5 - 10 percent!Face to face interaction, eye contact, listening to the patient, physical examination by the doctor ( the doctor's touch) are all important.
The case in point is a patient I saw on last Sunday. I was requested to see a "restless" patient on the Sunday evening. Restlessness would basically point to a problem in the heart / lung / liver / blood sugar related / nervous system related issues / alcohol withdrawal are main causes. The patient was confused and restless. On a detailed history taking from the wife and a diligent clinical examination I drew a blank. Then we do some basic investigations - a chest x ray failed to explain the restlessness. The blood sugar was normal. The ECG taken on modern machine was reported by the machine as "Abnormal - Suggests heart attack" pressing the panic button among the staff and the relatives. This is a bane of modern technology - report comes even if you do not ask for it! Actually, due to confusion and restlessness, the patient was randomly moving his fingers and hand resulting in random "elevation of ST segment and inversion of T waves" which technically amount to a heart attack . In a true heart attack, these changes are seen in all complexes in a given lead always whereas in a patient (like this) with movements, the changes are randomly seen in some complexes sometimes - this is made out only if the doctor observes during the ECG recording or records it himself. There were no abnormalities in the other systems mentioned above. He had not consumed alcohol of late.
The doctor sometimes has to become a detective. Time had come for that. I had overlooked something for sure. No excuse was good enough for that. I had to make amends and find out the truth. I called his wife again. I asked about recent behavioral change - sure enough he was doing double duty indicating manic phase of manic depressive psychosis. Then I asked about "daily medicines" that he takes - the wife suddenly remembered - she brought a strip of Alprazolam ( a benzodiazepine drug working on the brain ) which he was consuming more than 15 per day - which she believed was a tonic - obviously he was addicted to Alprazolam . He had stopped it suddenly - being accustomed to a continuous intake, it resulted in withdrawal features of which confusion, restlessness and abnormal movements are dominant. He had all of these and a correct diagnosis was made by talking to the patient's relatives. This re emphasies the need for talking to the patient and his family and making sure we are not misled by the advanced machines. We should not be the slave of technology - we should be the masters controlling the technology to our benefit and using it judiciously!
This brings us back to history taking - how important is it in this modern era of advanced technology? Is it not enough if a trained (not necessarily a doctor) person takes the data on a ticking basis saving time for the doctor? Sadly, NO. It is interesting to note that 80 - 90 per cent of the times the diagnosis is made by history and good clinical examination. All the new technology and the machines only help in refining further 5 - 10 percent!Face to face interaction, eye contact, listening to the patient, physical examination by the doctor ( the doctor's touch) are all important.
The case in point is a patient I saw on last Sunday. I was requested to see a "restless" patient on the Sunday evening. Restlessness would basically point to a problem in the heart / lung / liver / blood sugar related / nervous system related issues / alcohol withdrawal are main causes. The patient was confused and restless. On a detailed history taking from the wife and a diligent clinical examination I drew a blank. Then we do some basic investigations - a chest x ray failed to explain the restlessness. The blood sugar was normal. The ECG taken on modern machine was reported by the machine as "Abnormal - Suggests heart attack" pressing the panic button among the staff and the relatives. This is a bane of modern technology - report comes even if you do not ask for it! Actually, due to confusion and restlessness, the patient was randomly moving his fingers and hand resulting in random "elevation of ST segment and inversion of T waves" which technically amount to a heart attack . In a true heart attack, these changes are seen in all complexes in a given lead always whereas in a patient (like this) with movements, the changes are randomly seen in some complexes sometimes - this is made out only if the doctor observes during the ECG recording or records it himself. There were no abnormalities in the other systems mentioned above. He had not consumed alcohol of late.
The doctor sometimes has to become a detective. Time had come for that. I had overlooked something for sure. No excuse was good enough for that. I had to make amends and find out the truth. I called his wife again. I asked about recent behavioral change - sure enough he was doing double duty indicating manic phase of manic depressive psychosis. Then I asked about "daily medicines" that he takes - the wife suddenly remembered - she brought a strip of Alprazolam ( a benzodiazepine drug working on the brain ) which he was consuming more than 15 per day - which she believed was a tonic - obviously he was addicted to Alprazolam . He had stopped it suddenly - being accustomed to a continuous intake, it resulted in withdrawal features of which confusion, restlessness and abnormal movements are dominant. He had all of these and a correct diagnosis was made by talking to the patient's relatives. This re emphasies the need for talking to the patient and his family and making sure we are not misled by the advanced machines. We should not be the slave of technology - we should be the masters controlling the technology to our benefit and using it judiciously!
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