Hysterical or Historical!
Hysterical or Historical! The answer lies in the story!
Hysterical or Historical! The answer lies in the story!
Though this is a story inspired by my life, it is a story and experience faced by most medical professionals at some point in his or her life!
Its like the third year or final syndrome which every medical student goes through when he or she believes that he or she is suffering from the very disease they are looking at or listening about!
The patient will tell he or she has this pain and swelling and feeling and in an empathetic flow, the student will start getting the same symptom!
In most cases the hysteria can be helped by taking a proper history!
So as the story goes, it was my first week in Chennai and my language was a little rustic (that's being kind to myself!!).
In any case, what I have understood is that even if you speak polished English, when someone slaps you, the language you speak when you scold or scream at that time is the true language of your emotions!
And that’s the language you need to express!
So I got to examine this patient with complaints like ear pain, mild ear block and ear irritation. Since she was not able to understand my language, her husband helped with the history while she didn't utter a word!
Which was fine by me since an interpreter in time gets me a diagnosis!!!
So I do the usual investigation and send her for her tests.
As I was looking on the test results which were in my chief's hands and just like I suspected she had mild hearing loss probably due to a cold or so I thought!
My chief took one look at the patient and asked her what her problem was?
To this the patient replied in pure tamil that she had voice change and that she was a teacher by profession! That single line took me by surprise because just the speech and her profession would have clinched my diagnosis in an instant!
Needless to say then and there our chief took out a laryngeal mirror and diagnosed a vocal cord nodule!!
The look my chief gave me was the same which my dad gave when me as a child of five years old proudly announced to him one fine day that “Elephants also lay eggs!”
Of course the crux of the story is that most importantly though I learnt three things!
One is that always try to speak in the patients native language or the language which the patient understands!! Like I mentioned before, the emotions are raw and pure only in your own language! The reason why I try to learn the local languages as much as possible wherever I go!
Two is that never trust investigation results blindly and do rely on your own clinical examination findings (at least do them completely!!). I had seniors and teachers who would diagnose without any scan or X ray! Patients nowadays don’t get satisfied unless you ask for a scan or a blood work but in most cases it just creates confusion and panic! But defensive medicines makes us do these investigations! Even then, the experience and the clinical skill of the doctor is more important.
And third most important; Never trust the husband when it comes to telling anything about the wife!!
The most relevant point of the blog is that History is very important in the diagnosis and treatment of the problem and a proper history in most cases is enough to get the point across!
In modern times of course, its not only HIStory, it is also HerStory!
Now if you want Hysterical, then you can always check out the antics of Dr Hawkeye Pierce in the sketch in the series MASH!