• Listening carefully, I mean really listening, is the most important diagnostic tool in the doctor's bag, but it is rarely straightforward.
• "It's that pesky ulcer again," she said. "Just prescribe me more of that heartburn drug, and I'll be better..." But the pain progressed; the after-a-fatty-meal and recurrent nature of the pain story came out. With the added character of the exam and an ultrasound test, the diagnosis of gall bladder disease finally was made. Soon after, we removed the infected and almost ruptured gallbladder.
• "I have sinusitis and bronchitis, and need an antibiotic. Nothing helps until I get the antibiotic. Just give me the antibiotic," He demanded. And yet after learning of the two days of sore throat and ache-all-over, then the runny nose, and two weeks of cough, it was clear he had a viral infection, which in turn triggered some asthma-bronchitis-like problems. What he needed was inhaled steroid-asthma medicines and some time for the viral illness to run its course. That given, the correct treatment was provided, the coughing resolved, and an exposure to a dangerous antibiotic was avoided.
• "There's been blood in the toilet again but it's just my hemorrhoids," he said. It took some convincing to get him in for colonoscopy, but when we did, there was a large polyp turning to cancer out on a stalk in his colon, which was removed through the scope. Not what he expected, but his story brought us to save him from a cancer death.
• With all these misleading words, still the patient's story and the clinician's ear are the most important diagnostic tools available. Even with advanced technology, extensive blood and laboratory tests, complex genomics, and MRI, CT, and PET scans, the old-fashion taking a careful history is still the most important way to make the correct diagnosis. More than one research study has shown that laboratory and imaging tests make the diagnosis about five percent of the time, the physical exam about 15 percent, and the history about 80 percent.
• Of course it is important to use the right test when appropriate, but in this day and age, some would criticize modern medical providers for becoming too dependent on fancy and expensive tests, and for not taking enough time to listen, I mean really listen to what our patients have to say.