Symptom Attic: What’s it about? 

 

We are taught in medical school that when a patient comes in for an appointment, the diagnosis is evident 90% of the time after you've listened to their story ("taken the history").  Physical examination and investigations are only necessary to further explore or confirm the diagnosis.  So a lot of time is spent teaching us interviewing techniques, such as the appropriate use of open and closed ended questions.  This sounds great, but it’s not always that easy.

 

I remember one gentleman who came in with a vague complaint; after taking a lengthy history, I was absolutely no further ahead.  So I started again with some pointed closed-ended questions.  I asked “When did your symptom begin?”.  He stared into the distance for a long time, deep in concentration, then triumphantly looked me in the eyes and said “Sometime in the past”.

 

At times like that, I believe that a little bubble forms above my head where my thoughts are printed out, like in cartoon strips.  I can only hope that my patients cannot see the words.  On this occasion, the bubble said: “That’s helpful!  That rules out the future.” and “Think,..... were there dinosaurs?”   “Do you remember who the prime minister was?” Stubbornly refusing to give up, I asked another unambiguous closed-ended question “Does your symptom wake you up at night?”  After another performance that would have made Rodin proud, he told me “My wife says I’m restless at night”.  I gave up and ordered a bunch of expensive tests; surely THAT would help.

 

The best part of practicing medicine was the relationships with all these wonderful patients.  They trusted me with their stories, their fears, their secrets.  I loved listening to them and talking with them.

 

This song “Symptom Attic” is a tongue-in-cheek look at what might be going on in a doctor’s (or other therapist’s) head during a patient interview.  The choruses are deliberately confusing with some voices saying “Please make it go away” and others “Never let it go away”; this reflects my observation that patients have extremely complex relationships with their symptoms.

 

Yes, the scream of frustration after the last chorus is me!!