My specialist recently mentioned something about how important history taking is. 80% of diagnoses are made based on history while the remaining from physical examination & further investigations.
I’m sure you’ve heard the joke “double blind study” (ie. 2 orthopaedic surgeons looking at an ECG), but I bet you’ve not heard about the “quadruple blind study”. Well, here’s how the story goes:
I was the Surgical Medical Officer (MO) oncall at Sarawak General Hospital, when the ED (emergency department) MO paged me to see a patient with acute right sided lower limb swelling & pain, to rule out the possibility of deep vein thrombosis. The other differential diagnosis was cellulitis, so the Orthopaedic MO was also called in.
4 doctors (ie. the ED, Surgical & Orthopaedic MOs, as well as the ED specialist) stood at the end of the bed & looked real hard at the patient’s leg, but none could come up with a diagnosis. After much discussion about the possibilities, including neuromuscular conditions, our patient (who had been keeping quiet & listening to the doctors) spoke, “Doktor, saya rasa saya ada gout lah. Dari dulu lagi, saya selalu kena macam ini.”
If only one of the doctors had asked the patient if he had similar symptoms before…
