The point of the above commentary is not to point out the obvious that my life is less than a thrill-a-minute. It is to illustrate that we have become a society that takes things in only in bits and pieces and we remain absolutely certain that we have a grasp of the situation. In the doctor’s office this phenomenon has serious repercussions. Patients come to office and the doctor will ask, “What’s wrong?” So far, so good. The patient will respond, “I have headaches.” The doctor then asks in machine gun-like fashion, How often do you get them? Have you had them before? Etcetera, etcetera. The patient will begin to answer and in the measured average amount of time of eighteen seconds, the doctor will interrupt the patient in order to ask another question or begin to prescribe the latest potion for headaches. The patient and physician probably will not recognize that the real problem has been missed completely. For generations, physicians have been trained to offer what is known as a physician-oriented model for conducting a patient history. Specifically, the doctor asks questions and the patients fill in the answers. Because our means of communication in society have become so sharply time-sensitive, all forms of information transfer have become seriously flawed. It may not be all that important in considering the latest twist in a TV sitcom or in reviewing the baseball standings. It is, however, very significant in the doctor’s office. Recognizing these problems, physicians are being trained in a different technique known as patient-oriented history taking. In this pattern of health information acquisition, the doctor starts by asking, “What’s the problem?” The patient responds, “I have headaches.” The doctor then asks, “What else?” The patient then responds, “I am worried about my son.” The doctor, breaking with generations of “Harvard-ist” training, asks again, “What else?” The patient begins to weep and says, “My son is using drugs; he has been arrested and I don’t know what is to become of him. I am worried sick. My headaches start when I think of his situation.” In the standard history format, the patient is sent home with a pain pill or perhaps an order for a CAT scan of the brain or even a neurological consultation scheduled for six-weeks into the future.

In the second scenario, the doctor and the patient have come to an important revelation that will provide the basis for on-going care .Of considerable interest to physicians who may say that such a patient-oriented history takes too much time, a study of the matter at the Mayo Clinic led to the conclusion that this technique took no longer than the older method and was much more likely to improve the relationship between the clinician and the patient. It also set an agenda for care that was more acceptable to the patient and more effective in providing a health benefit.

While the medical profession is trying to find more effective means of communicating with patients and in gaining important health information, the patients must also give their complaints some serious consideration before coming to the doctor. Patients cannot present a complaint without any useful supporting information. For example, one patient told me he had a stomachache. He did not choose to share with me that he would take up to 100 aspirin per week. When asked about aspirin, he said only, “I take a few now and then.” His wife came into the examination room at the end of the visit and said to me, “ Now you be sure to tell him not to take Goodies anymore.” Such errors in the history database are more likely in our “channel surfing” mode of communication of today. On the other hand, it is still the role of the physician to figure out the cause of the complaint. In a world of sound bytes, channel surfing, and rude interruptions, it is easy to see how the medical office visit can be a useless event in the guise of providing healthcare. Perhaps both the doctor and the patient should give the office visit more than 3.1 seconds of attention.