Saturday, April 28, 2018

Patient histories should tell personal stories too - The Washington Post

One of the fundamental skills we learn early in medicine is how to take a patient history. We are encouraged to tell a story. Yet these stories have a specific formula. They go something like this: "Mr. A is a 60-year-old man with high blood pressure and diabetes who presents with new left lower extremity weakness." We describe when the weakness started, what makes it better and what makes it worse, and any other accompanying symptoms.

Most often, we elicit a story of disease but not one of the patient who is experiencing an illness. The best stories are cut short. Mr. A's story may not communicate that he has been homeless for months because he lost his job. Or that his daughter is getting married in a few months and that he is most concerned that he will not be able to walk her down the aisle. Both of these stories — about the illness and about the patient — are important in different ways.

When we look at the medical chart, we can read multiple notes without learning any information that tells us who our patients really are. But what if we could sit down with our patients for an hour and learn about them as people?

So I was intrigued when I heard about the My Life, My Story program started in 2013 by Eileen Ahearn and Dean Krahn, psychiatrists at the Veterans Affairs hospital in Madison, Wis. With My Life, My Story, veterans have the opportunity to tell their story through interviews. These interviews are conducted by volunteers, social work interns, medical students and staff, and others.

Each story is approximately 1,000 words long and written in the first person. Suggested interview questions include: "What has been the most significant change you've seen in yourself? What is most important to you? What are you most grateful for? What do you want your health-care team to know that they don't already know?" There are no medical questions.

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