A person who feels ill really wants their medical provider to understand, so they often rehearse to themselves exactly want they want to say and communicate. They may also have an idea as to why they feel sick. That’s all well and good, and we clinicians are eager to hear it all, to a certain point. But sometimes we need more or different information, so we delve into a series of our own questions, which may not make sense to the patient, even offending them.
Please bear with us, since we have our own ways of figuring out what a patient might or might not have, requiring specific information the patient may not have thought about. Our goal is, after all, to understand what you, the patient, are feeling (as Bill Clinton famously / notoriously said, “I feel your pain”).
A patient’s best guess as to why they’re sick may be wrong, and our questions can help figure that out. Please allow us to doubt you. We may know of some possible catastrophic conditions we want to be sure you don’t have, which you may not be aware of.
The main criterion which helps us (or at least me) make a diagnosis is the time course of a symptom. For example, a burst artery in the brain or belly causes sudden onset of pain that reaches its peak intensity almost immediately. So pain that developed gradually over hours or days will be something else. Symptoms from a growing cancer get progressively worse over time. Symptoms which occur, disappear, and reoccur have their own sets of diagnostic possibilities.
In terms of time course, it’s much more important for us to hear the more recent evolution of a symptom, than to hear how it appeared many years ago. We do want to know the first time you ever experienced it, and how often it recurred from then to now. But it winds up being easier for us picture things by understanding recent changes as opposed to prior ones.
Try not to use medical terminology when describing symptoms. I’ve had patients try to sound educated, but use the terms incorrectly, sometimes the opposite of what they mean. That doesn’t help; use the simplest lay language available that leaves no doubt.
Speaking only for myself, I love when patients ask me whether they could possibly have this or that, and why I think so. That’s always preferable to their telling me the diagnosis, which tends to shut off any ongoing thought process. As a warning, some very busy clinicians will simply not argue, which may not be in a patient’s favor.
As mentioned elsewhere, we make most of our diagnoses from the patient’s history. Physical examination rarely helps very much (listening to the lungs is a main exception). Laboratory tests and x-rays don’t help that much either (see Diagnostic Thought Process).
One purpose of this website is to help readers understand what we clinicians seek in order to reach a diagnosis, allowing patients to take an active part in the process.