Upstate Neurosurgery Practice

How to Take a History—General Comments

  1. Medical problem solving in general, and conferencemanship in particular—When thinking about these things, and especially when discussing these items in conference, take it a step at a time. Don't leap to your brilliant diagnosis in one jump. You will wind up getting eviscerated by your professors for a very good reason.

    If you leap and you're right, horray for you. But if you leap and you're wrong, you have no way to retrace your steps and correct your thinking. On the wards, this can lead to misdiagnosis. This can be bad. The world, in case you haven't noticed, is a pretty sloppy and confusing place, medicine no less than the rest of it. If you work methodically towards your answer, you will have a far greater chance of trapping the (correct) beast, rather than getting trapped yourself. So pace yourself. Do it a step at a time. Slow down. Listen for help. Unless your professors are particularly malignant, most of their comments will be attempts to help you out.

  2. Never fall in love with a diagnosis.—This is a modification of the old stockbroker's adage, "Never fall in love with a stock."

    Sure you made a brilliant diagnosis, discerning and integrating facts that others were too blind or hidebound to see. Of course your brilliant detective work will work out and redound to your eternal credit. Sure. Until it doesn't, and the universe (aah the universe...) shows you that you were wrong. So be willing to accept that you are wrong, and keep your algorithm alive so that you can back up in good time to correct your errors. Nobody is infallible, at least in medicine.

    Remember that we said we'd forgo the theology, right?


  3. Don't forget the ABCs—Remember that the point of this whole exercise is to make patients better.

    Don't get so wrapped up in recondite diagnosing and treating that you miss the fact that your patient is going down the tubes.

    If in every emergency, you train yourself to say, aloud if possible, "ABCs" you will go a long way towards being a good doctor.