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Being A Medical Detective . . . And A Doctor

By EmpowHER December 10, 2010 - 3:30pm

Written by: Dr. James Kelley

As an emergency physician, I can tell you that the practice of medicine is about solving mysteries. Why do I have this pain? What is causing this? Is it serious? Is it cancer? Most of us experiencing some manner of medical symptoms have confronted the possibilities behind our symptoms and have asked these questions.

Questions and answers are central to achieving an accurate diagnosis. It’s said that 90% of the diagnoses come from the questions asked and the answers given rather than from the physical examination. Testing plays an important role, but ordering the right test relies on asking the right questions to be answered by that test. As physicians we are medical detectives with a mystery to solve.

The detective works begins by determining the symptoms and relationships based on the medical history. The basic structure of our line of questioning for a symptom is: location, onset, quality, timing, severity, and associated symptoms or situations. As patients, you can help your doctor to be a better detective by organizing your information. Some patients make an attempt at this by writing down all sorts of details about their illness. Too often, this is a misdirected effort at listing every blood pressure, blood sugar, quantity and nature of every meal and every sensation they have felt during the period of illness. A better use of time would be to organize around our line of questioning and recording the location, onset, quality, timing, severity, and associated symptoms or situations for any set of symptoms.

I’ve had patients with memory impairment arrive in the emergency department with stacks of old medical documents but nothing describing the present observations or concerns. As you can imagine, if the patient can’t answer questions and the documents don’t provide answers, I’ve lost a good portion of the medical evidence. It’s elementary my dear Watson! Organize your clues and provide clues for those who can’t!