The Abbott Way: The Life History

Part I: Life Story

              Rather than begin the conversation with the prodding question: “What brings you in today? or “Can you describe the pain you are having?” why not start with something different like “Tell me a little about yourself,” or if you are well acquainted already “What have you done since we last talked,” or even “What was it like growing up in…? While some people may look at you and simply say my throat hurts and I need some medication, most people when given the open-ended opportunity to share their life story become quite revealing, honest and overall quite happy. Some may even forget about their discomfort altogether during the recollection of playing capture the flag in elementary school, or sharing the wonders of a recent vacation. A History of Present Illness is overrated, if given the chance to hear a person’s life story first, we can much readily come to realize who and why the patient’s current symptoms are imparting suffering. The reality of illness is that it is entirely a subjective experience, yet we are focused only on objectifying symptoms, quantifying pain or categorizing a collection of symptoms into distinct syndromes. If I cannot understand which symptoms are disruptive to the patient, how the patient’s experience of the symptoms is leading to impaired well-being and most importantly, how a patient’s mental and emotional relationship to his or her current malady is ultimately manifesting as his or her experience of the illness, I will never successfully provide healing, This may come as a shock, but just because Sudafed is used as nasal decongestant, doesn’t mean I should prescribe it or suggest its use to someone presenting with such a complaint. What if an individual’s fundamental issue is spending too much time in a crowded, moldy office building with inadequate ventilation, or the individual has food intolerances to dairy products due to underling intestinal permeability, yet they do not experience overt abdominal bloating or pain, but are exhibiting systemic signs of congestion and inflammation? And what if an individual has had chronic joint pain for the last 20 years and only recently developed a common cold; if you decide to solely target treatment to the osteoarthritis, and provide some degree of relief, yet do nothing for the viral illness, you might find that the patient loves you eternally for their newfound ability to exercise in minimal pain even if there sinuses are still as congested as the Hampton Roads Bridge Tunnel. So instead of taking a formal history with a focus on a chief complaint, start with a life history and you may be surprised to find you may find out about grandma Ida’s heart attack and your patient’s past history of alcohol abuse all the same as if you had asked them in as laundry list. Many current physicians can agree that most illness and disease can be diagnosed by a thorough history in lieu of imaging and laboratory tests. I would argue, however, that without establishing a degree of comfort and trust by obtaining a life story from your patient, who is to say what they tell you is truthful, accurate or complete? Gaining trust is essential to practicing effective medicine, and while a thorough history most certainly can diagnose almost any condition, only by connecting to a patient and elucidating a life story can you most certainly provide a means to heal.