As students of medicine, we have always placed an esteemed emphasis on "history taking." A process of listening to the patient while gathering clues to the ailment. William Olser, often described as "Father of Medicine," had this to say on the matter:
Alas, Dr Osler lived in a world without electronic medical records (EMRs). I sometimes find myself pausing in embarrassment while gathering information from the patient alongside the EMR. "How many doses of zoledronate infusions have you received so far?" I would be asking the patient while simultaneously pulling up the medication administration record. They would tell a number that turns out to be completely different than what has actually been given. As we find out a different record of actual medication administration, patient winces, and I blame myself for putting her on the spot by asking the question. I could have just explored the EMR beforehand to gather that data for something that I can hardly rely on patient's memory. And over the years I have learned how unreliable it is to base decisions based on patient recall. On my good days now, I would have performed a thorough exploration of patient's EMR and gathered necessary information before I enter patient's room to talk. Good students of medicine these days put due diligence in gathering exhaustive information from EMR. I am certain Dr Osler would have emphasized this in more eloquent terms were he around.
Still, the importance of listening to patient holds an irreplaceable import. There are no descriptions of patient's emotional states by a clinician's notes that can substitute a voyage of thoughts in a calm absorption of patient's patter. No algorithm of information can match the patient's descriptions of their priorities and beliefs. You might have the right answers for the disease afflicting the patient. But listening and talking with the patient is where you build the trust. Ultimately, we humans are not automatons making decisions on rational choices. Our patients weigh their trust on us to adopt our recommendations. We might be brilliant in medical sense but if they do not find an emotional plane of trust, they might not adopt our solutions, even if by objective measure it is a wrong choice.
Recently, we have been introduced an oxymoron term "alternative facts." While the messenger received some serious criticism, unfortunately, there is a populace who share her belief. If we were to heed the back and forth between the protagonists and antagonists of the alternative facts, we might find ourselves confused about the reality itself. If we do not belong to any particular ideological camp, we might throw our hands up in the air and say the world is an illusion anyway! There is no reality!
As I think about this I can not help going back to the EMRs. There I see two discernible aspects of realities in that interaction:
1. Objectively verifiable information (e.g. the information about what date, time zoledronate was administered)
2. Interactions involving feelings/thoughts
The objective information is fixed and incontestable. If the patient has received medication only in this facility and there is no reason to doubt the accuracy of documentation, that information is incontestable. There is no subjectivity.
But in our human interactions not everything is objective and fixed, we rely on feelings and perceptions. We imagine. We dream. Not by threading the plausible and actual but rather freewheeling in the cloud, in the subconscious, beyond our realm of reasons and rationality. Do I like this doctor? Does he sound reliable?
We are entitled to an unbridled freewheeling in the perceptual realm. But if we try to claim that objective reality should also acquiesce to our perceptual world, that's when the problem springs. When we start claiming that our feelings of the number of zoledronate administered should trump the objective documentation of administration, there is a serious problem. There is the world of "alternative facts."
I do not want my doctor to rely on her feelings about the objectively verifiable information to decide on my health. It is also clear that the society should not rely on "alternative facts" to run the governance.
It is still a dictum we hold close to our heart and try to impress upon our students and trainees."By historical method alone can many problems in medicine be approached profitably."
Alas, Dr Osler lived in a world without electronic medical records (EMRs). I sometimes find myself pausing in embarrassment while gathering information from the patient alongside the EMR. "How many doses of zoledronate infusions have you received so far?" I would be asking the patient while simultaneously pulling up the medication administration record. They would tell a number that turns out to be completely different than what has actually been given. As we find out a different record of actual medication administration, patient winces, and I blame myself for putting her on the spot by asking the question. I could have just explored the EMR beforehand to gather that data for something that I can hardly rely on patient's memory. And over the years I have learned how unreliable it is to base decisions based on patient recall. On my good days now, I would have performed a thorough exploration of patient's EMR and gathered necessary information before I enter patient's room to talk. Good students of medicine these days put due diligence in gathering exhaustive information from EMR. I am certain Dr Osler would have emphasized this in more eloquent terms were he around.
Still, the importance of listening to patient holds an irreplaceable import. There are no descriptions of patient's emotional states by a clinician's notes that can substitute a voyage of thoughts in a calm absorption of patient's patter. No algorithm of information can match the patient's descriptions of their priorities and beliefs. You might have the right answers for the disease afflicting the patient. But listening and talking with the patient is where you build the trust. Ultimately, we humans are not automatons making decisions on rational choices. Our patients weigh their trust on us to adopt our recommendations. We might be brilliant in medical sense but if they do not find an emotional plane of trust, they might not adopt our solutions, even if by objective measure it is a wrong choice.
A good doctor in the current environment is one who can be exhaustive at data gathering from the EMRs, capable of listening and connecting to the patient, agile in compiling information needed to manage the issue in the most evidence-based manner, able to synthesize emotional information with objective data, and masterful in conveying the information in literally and emotionally understandable terms to the patient.
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Recently, we have been introduced an oxymoron term "alternative facts." While the messenger received some serious criticism, unfortunately, there is a populace who share her belief. If we were to heed the back and forth between the protagonists and antagonists of the alternative facts, we might find ourselves confused about the reality itself. If we do not belong to any particular ideological camp, we might throw our hands up in the air and say the world is an illusion anyway! There is no reality!
As I think about this I can not help going back to the EMRs. There I see two discernible aspects of realities in that interaction:
1. Objectively verifiable information (e.g. the information about what date, time zoledronate was administered)
2. Interactions involving feelings/thoughts
The objective information is fixed and incontestable. If the patient has received medication only in this facility and there is no reason to doubt the accuracy of documentation, that information is incontestable. There is no subjectivity.
But in our human interactions not everything is objective and fixed, we rely on feelings and perceptions. We imagine. We dream. Not by threading the plausible and actual but rather freewheeling in the cloud, in the subconscious, beyond our realm of reasons and rationality. Do I like this doctor? Does he sound reliable?
We are entitled to an unbridled freewheeling in the perceptual realm. But if we try to claim that objective reality should also acquiesce to our perceptual world, that's when the problem springs. When we start claiming that our feelings of the number of zoledronate administered should trump the objective documentation of administration, there is a serious problem. There is the world of "alternative facts."
I do not want my doctor to rely on her feelings about the objectively verifiable information to decide on my health. It is also clear that the society should not rely on "alternative facts" to run the governance.
