The Art of Asking: What Else is Going on?

By HANS DUVEFELT Walter Brown’s blood sugars were out of control. Ellen Meek had put on 15 lbs. Diane Meserve’s blood pressure was suddenly 30 points higher than ever before. In Walter’s case, he turned out to have an acute thyroiditis that caused many other symptoms that came to light during our standard Review of Systems. Ellen, it turned out, was pretty sure her husband was having an affair with one of his coworkers. And, since this wasn’t the first time, she was secretly working on a plan to move out and file for divorce. She admitted she’d always had a tendency to stress eat. Diane’s daughter had just announced that she was pregnant by a man she wasn’t sure wanted to be around in the long run. How do we know whether a patient’s subjective symptoms, laboratory values or even their vital signs are caused by their known medical conditions, a new disease or their state of mind? We are often tempted to proceed down familiar tracks and tackle seemingly straightforward problems with medications: More insulin would take care of Walter’s blood sugar. Ellen could use a couple of months of phentermine. Diane needed a higher dose of lisinopril or perhaps some hydrochlorothiazide. As Sherlock Holmes said, “there is nothing more deceptive than an obvious fact”. There are all kinds of algorithms and guidelines that are supposed to inform clinicians in situations like these, but I wonder how often they are helpful and how often they migh...
Source: The Health Care Blog - Category: Consumer Health News Authors: Tags: Medical Practice Physicians Primary Care Hans Duvefelt health communication Source Type: blogs