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!!