History of Present Illness

Abstract

Eighteen seconds. Maybe 23 s. That’s all the time an average patient has to tell his story before he is interrupted. Seventy percent of patients never get to finish their story [1, 2]. Why? The obvious answer: physicians feel rushed for time. However, that does not explain the 18 s fully. Why not interrupt after 2 s? I think the 18 s is a cursory attempt to listen to the patient before moving to the real task of the interview: gather symptom data needed for diagnosis. It is a false dichotomy. During the opening phase, the clinician listens to the patient and begins to gather psychosocial and biological data needed for accurate diagnosis (see Chap. 2). This takes 3-5 min to accomplish, not 18 s. The clinician listens to the patient and gathers data during the second phase of the interview as well. Only, the emphasis shifts to gathering the data that the patient does not spontaneously offer and that the clinician needs for accurate diagnosis.

What else could it be? is a key safeguard against these errors in thinking: premature closure, framing effect, availability from recent experience, the bias that the hoof beats are horses and not zebras. … So a thinking doctor returns to language. ‘Tell me the story again as if I never heard—what you felt, how it happened, when it happened.

Jerome Groopman, How Doctors Think