Medical Matters: Diagnosis

People always ask me what kind of doctor I want to be, and although I’ve got a couple of ideas (a kick-ass glamorous one who studiously avoids contact with phlegm obvs), I’m still quite open to the idea of what I might end up specialising in. I’ve got to try it all out first because some things sound amazing – “I SAVE BABIES! I RUN AROUND WITH A DEFIBRILLATOR! I PUT MY HANDS INSIDE BRAINS!” – but who knows, maybe the prospect of an in-depth association with rare skin diseases may eventually prove unavoidably alluring. One thing I probably won’t end up in though is any kind of research, because I’d rather be talking to someone than reading academic papers, and because I come out with ‘facts’ like this on a regular basis:

‘80% of medical diagnoses are made from the patient history alone’.

There you go. That’s an interesting idea isn’t it? If I was more academic and better at writing papers I’d find the source of that information and tell you if it was true or not. Alas, I’m not, so all I can say is “My teacher, Mrs G, told me it and I believe her because she has that sort of face”.

A patient history is that seemingly endless list of questions your doctor asks you in the hope of getting to the root of your problem. It starts off very broad and gets more specific, and although sometimes it can seem irrelevant (“Do you have any parrots at home?”), there is, amazingly, a master plan at work. Although medicine does involve lots of bone parts and myriad invisible and theoretical gates and loops and processes, what underpins it – to my mind at least – is a series of patterns, which is to say that if you have, say, an ulcer, you will often (although inconveniently not always) present to your doctor with a similar history and experience as another person who has also had an ulcer. The purpose of a history is to look for these clues and patterns, and hopefully point towards some possible theories which you may or may not confirm with tests and investigations, depending on whether or not you think it is warranted.

So then, for the purpose of this post, let’s talk about stomach ache (SHUT UP, THIS IS FUN, OKAY?).   If you tell Twitter, you’ve got a stomach pain and are being sick, what responses do you get? As previously stated, I’ve done absolutely no research on this so I’m going to go with my Scientific Gut Feeling and hazard a guess that people will say the following things:

1. Awww, babes xxx (because Twitter is essentially a lovely kind place unless, y’know, anything’s happened in the news)

2. We’ve all had that here mate, there’s a bug doing the rounds xxx

3. I always get that, drink some camomile tea pet xxx

For the sake of clarity, I want to say at this point that there’s absolutely nothing wrong with any of that, we all do it, I do it all the time. After all, you go to online people mostly for sympathy and reassurance rather than medical opinion, which they would be irresponsible and wrong to give. If you want to find out what a doctor thinks, you need to go and see one. I’m saying it merely to make a comparison – when we consider it a ‘lay’ matter, we’re all quick to diagnose not just each other but ourselves, and remedy things accordingly. We base that diagnosis on our own experience, or things we’ve heard about, but what we very rarely do is delve any deeper into the matter.

If you were concerned enough to get a bit more medical and take your stomach pains to the doctor, they might approach it rather differently. There’s a fairly set pattern to taking a complete history (which isn’t always necessary), but I think I’ll wang on about that on a different occasion and just talk today about PAIN. Doctors love talking about pain, and like to get really into the nitty-gritty of exactly where, what and how you feel it. Not because they get any kind of pleasure out of this, or because they’re really nosy (although, disclaimer: I AM REALLY NOSY), but because finding out the small details will quite often reveal a pattern which can hopefully be recognised, confirmed and treated.

So, this stomach ache we’ve got, yeah (Are you still with me? Stay with me), let’s talk about that. There are lots of snazzy little frameworks about to help medical folk remember to ask all the right questions, but my personal favourite is SOCRATES. Thusly:

Site – Where is this pain exactly? Splitting the abdomen up (not literally, like, but IN YOUR MIND), into a noughts and crosses grid gives you nine areas, and pain in different ones of these points to different sources for the pain.

Onset – How long have you had it, and how quickly did it start? Again, different illnesses/diseases have different patterns of onset.

Character – What sort of pain is it? Interestingly enough (in a geeky about linguistics type way), people often use the same words – a dull ache, a sharp stabbing pain – to describe pains when they have the same underlying conditions.

Radiation – Does the pain move? For example, in a very classic textbook presentation of appendicitis, most of us know that you feel the pain in your lower right belly. BUT DID YOU KNOW, in that same classic presentation, the pain starts off in the central abdomen before radiating down? See, aren’t you glad you stuck around for this?

Associations – Does anything else happen when you experience this pain?

The others are Time course, Exacerbating/Relieving Factors (stuff what makes it worse/better) and Severity, but frankly, I’m a little bored of this list and I imagine you are too. Suffice to say, this list of questions is what takes you from ‘girl with stomach pain’ to (please use your best ER voice for this), ’35 year old woman presenting with severe right-sided stabbing abdominal pain of sudden onset, four-hour duration associated with nausea and vomiting and relieved by lying down and abstaining from food’. Sounds totes profesh, dunnit?

Of course, not everyone handily presents with a pain, but if they do and the medical staff treating them ask these types of questions then they’ve got a good starting point to maybe make some guesses as to what’s going on and start sorting the person out. Isn’t that amazing? Making a diagnosis just by ‘having a conversation’? After all, according to Mrs G, 80% of diagnoses are made just by CHATTING to people and asking the right questions (this satisfies so many of my thwarted amateur-detective ambitions).  So there you go, there’s a start to explaining some of the stuff we learn at medical school and why sometimes your doctor asks you a bazillion questions and doesn’t necessarily do any tests. You may care, you may not, but well done if you got this far, you deserve a lollipop. Do any doctors still do that? THEY SHOULD.

 

 

 

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4 comments
  1. jenniferheidi said:

    My husband’s just spent four days in hospital with suspected appendicitis. It was pretty much diagnosed by his history and confirmed with a blood test and scan so it’s cool to read about the processes you learn to get to that.

    My favourite bit was when he was asked where the pain was and said, all nonchalant like, “On my right hand side but… Oh yeah, last Sunday it was in the middle and then it moved to the right…” and I had to stop myself screaming, “THEN WHY DIDN’T YOU SAY SO AT THE TIME?!”

    Anyway, thanks for the post. I’ll look forward to more 🙂

  2. Lovely post – and very interesting. Because I spend all my days researching, I found your source for the 80% stat. It’s this one: http://www.ncbi.nlm.nih.gov/pubmed/3655965 And doctors who ask questions are great – especially if you feel like crap and can’t gather your thoughts properly. I can imagine you’d be very good at that side of it. 🙂

    • Irregularly Irregular said:

      AMAZING, THANK YOU! Between us we could write quite the paper! I knew Mrs G wasn’t fibbing! Xxx

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