Press-Citizen (Iowa City, IA), July 11, 2012
By Carol Scott-Conner, a professor of surgery at University of Iowa Carver College of Medicine, author of the book of short stories titled A Few Small Moments.
Every year, we teach new medical students how to take a medical history. An adequate medical history succinctly summarizes the facts of the case — the chronology of how a particular episode of disease evolved. A good medical history tells how the illness affected the individual patient, and an extraordinary one almost brings the patient to life in front of the reader.
I’m a surgeon. Patients usually come to me with a diagnosis already made. But I still sit down and ask, as I was taught, “What happened? How did this all start? And then? What happened then?”
Often the patient says, “Didn’t you get my records?”
Yes, I did. But I want to hear it from the perspective of the most important person in the room — the patient.
Patients, you see, form their own narratives of illness. In New York City, where I trained, stories often began on other continents, in different worlds. When I practiced in West Virginia, illness sometimes began when a feuding neighbor “poisoned our well.”
Sometimes that “cultural context” provides the missing piece of the puzzle.
But the history-taking provides another benefit as well.
For all of our advances, surgery remains a very primitive but effective form of healing. Part of what I must do with each new patient is to connect on a basic human level. That connection becomes a healing relationship that will, I hope, give the patient sufficient confidence to allow me to perform the necessary surgery.
The history goes into the medical record. It is a constant reminder that the patient is an individual, rather than “the breast cancer in room 3.”
When I teach medical students and residents how disease is diagnosed and treated or experienced, I often pull out stories. “Let me tell you a story,” I may say, as I gather my thoughts to explain the difficulties that patients sometimes have to surmount.
Or I may pull out another story to explain how difficult it can be to make a particular diagnosis. I may even pull out an apocryphal tale that I was told, a horror story told down generations of physicians to show how our actions can have unintended consequences.
A surgeon’s work is filled with stories.
Subjects Covered: healing, medicine