What brings you in today? With more than 857,000 practicing physicians in the U.S. repeating it numerous times a day, this might just be the most frequently asked question in America.
Though there are as many answers as patients, what often prompts people to seek medical attention is pain.
Two physicians at Rush University Medical Center share how they approach patients to ensure an accurate diagnosis and individualized treatment.
Where, when and how does it hurt?
Not surprisingly, it's chest pain that sends many patients to cardiologist Melissa Tracy, MD. Her questions — which include "How long have you had this pain?" and "Does it move or stay in one place?" — direct her to the top possible causes for the pain. As she listens to the answers, she mentally reviews potential diagnoses, eliminating some and adding others in a dynamic process she's developed through extensive training and experience.
"One key diagnostic question is, 'When does your pain occur?'" says Tracy. "That's very important because chest pain when someone is exerting him- or herself is typically going to be associated with the heart — as opposed to being something nonthreatening, like indigestion."
Tracy also asks female patients a question that, since she's not a gynecologist, often surprises them: When was your last period? "I need to know if they're still menstruating because a woman's risk of developing coronary artery disease — the build-up of plaque in the arteries that can lead to heart attacks — starts to equal that of a man's risk about 10 years after menopause."
What else is happening in your life?
According to Nancy Bryan, DO, an internist at Rush, abdominal pain is a common reason women come to her. "I always ask when the pain started and if it has happened before. Then I ask, 'What have you done to make it better?'" Bryan explains. "This helps me understand the nature of the pain. I also ask what they think is causing the pain and what concerns they have about it."
For women with abdominal pain, Bryan first rules out the most serious issues, like appendicitis, gallbladder disease or inflammatory bowel disease. "But I also ask the patient about her family and what's going on in her life," she says. "I might learn her husband was laid off, she lost her health insurance and she's worried about her mortgage payments. That's a really big deal, and it suggests stress may be the source of her pain. If I only ask the standard questions, I'll never find these things out."
For each patient, Bryan is seeking this: a family history; a history of the present illness; and a social history, including current circumstances. She believes getting that social history is key to providing care for the whole person.
Are you prepared?
Being prepared to share those family, medical and social histories — as well as to ask the doctors questions, even about embarrassing subjects — can save patients time and money that might otherwise be wasted on duplicating tests or following leads that have already been eliminated.
Bryan recommends creating a personal medical file and bringing it to every appointment. "Then you can answer the doctor's FAQs without forgetting the name of your blood pressure medicine, when you last had a stress test, or what health issues your parents and grandparents have," she says. "And if you've Googled something and found scary information — be sure to tell your doctor."
Bryan and Tracy both stress the importance of collaboration between doctor and patient. "We can't know everything that's going on with you. So it's important for patients to ask questions too," says Bryan. Tracy adds, "When it comes to your health, it truly is a team effort. We're in this together."
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