Accurate Diagnosis is a Team Sport Part 1 of 4

The Story You Tell.

A thirty year old woman is on her couch catching up on Steem when she suddenly breaks a sweat, becomes short of breath and has pain in her chest. Is this the heart attack her dad warned her about? Is it a blood clot in her lung? Could it be her pancreas giving her a bad time? What about a spontaneous collapse of her lung? Or, is it the result of that burrito binge she had with friends after work a couple of hours ago?

The description of her illness to the allied health, nursing and physician staff she meets is a critical component of reaching an accurate diagnosis.

Why is this important?
A cogent, precise story is vital to assist your care team devise an efficient and accurate mechanism for reaching the answer to what is wrong with you. Diagnostic accuracy is the result of choosing the most impactful examinations and testing. It dictates the treatment most appropriate to your situation. It informs you what your life will look like in the future and how quickly you can overcome an illness and resume the life you love. It results from an accurate story from the most important person in a medical situation. It comes from YOU.

What are the parts of a strong story?

Well, this is all about history. Not the past five years of your life. But, the thing that has brought you to need emergent care.

The following are suggestions for how you can help yourself and the rest of your team:

1.   Tell the story well. Be clear, concise and complete. “I’m sick” does not give me a lot to go on. (yes, I hear that every day) Think about what you are experiencing. Can you characterize the discomfort? Are you nauseous? Are you suffering with diarrhea? A headache? What else? The more you can tell us, the better we can care for you.
   

2.   Know the time of your symptom onset. What were you doing when it occurred? Did it follow a meal? Was it after exercise? Did it occur in a moment of emotional distress? Write it down!
   

3.   Be accurate…every time. If you interact with organized medicine, chances are good that you will tell the tale multiple times. We are human and remember things in situ. But, trying to get the complete picture from early in the visit will increase the effectiveness of your care.
   

4.   Remain a great historian. Have you had these symptoms before? What diagnosis was given? Have you had prior testing? What were the results? What makes it better? What makes it worse?
   

5.   Write it down if you have time. A voice text works just as well. Formulating the story in written language helps you firm up what is going on and puts your caregivers way ahead.
   

6.   If this is a chronic or subacute problem, do some sleuthing. Some physicians are not fans of patients googling symptoms. I am not one of these. I appreciate when someone asks, “do I have____...I just read about it”. 
   

Patient education is strongly linked to better outcomes. By doing a little research, you have demonstrated that you care about your health and you are teachable. Of course some sites are better than others. Both Mayo Clinic and Medscape have excellent patient education resources.

Nobody plans to have a medical emergency at the start of their day. By taking a few minutes, you can make that visit to a physician a more valuable use of your time and your health!

Steemdoc is a board certified emergency physician with a passion for diagnostic accuracy. He is new to Steem sports and would appreciate suggestions for how to improve.
The above information is drawn from recommendations described in Improving Diagnosis in Health Care published by the National Academy of Sciences Engineering and Medicine. This is Part 1 of a 4 part series in which we will try to make interactions with healthcare more beneficial to the most important member of the team, the patient.