The Medical History.

          This is a not a story  to criticize health care providers, but to criticize what has happened to a health care system that was once an example of excellence but despite  many technological advances has deteriorated over recent years.  That is because the medical history and physical examination, once the sine qua non of good medical care has faded in significance when compared to the apparent ease and precision (and to some the glamour) of high tech investigation.  It is often forgotten that those investigations, valuable as they are should be to confirm or correct the impressions the physician has formed from the patient history and physical examination.  It has been well established that indiscriminate investigations can result in much harm and expense.   Usually, the patient will tell you the diagnosis if you listen carefully and discriminatingly.

           After an accident in Hilton Head, S. Carolina, my seventy-seven year old wife tripped over a concrete parking marker and hit the ground with an impact that was potentially disastrous.   After observing her throughout the night and deciding her condition was stable.   I headed back to Canada the following morning.  By then, she had a black eye, the whole side of her face was swollen and her right hand was swollen and bruised.  We arrived home, in London Ontario, two and a half days later, after an ordeal, that I’m sure you can imagine.  She looked as though she had been badly beaten up and the sunglasses she wore to try to disguise her injuries merely emphasized them.  To cut a long story short, first thing in the morning, after arriving home, we took a trip to the emergency room, at University Hospital, and that’s where this story really starts.

            On the morning of Wednesday, twentieth of February, 2013,  I brought my much bruised and battered wife to the Emergency room at University Hospital, in London.    We sat there for five hours.  I am a physician and I was satisfied that my wife was in no immediate danger.  I couldn’t help speculating on what might have happened  if a patient  was bleeding from a subdural hematoma or worse during that period of time, with no one to monitor her.

             Because her hand and arm were grotesquely swollen and bruised, they were the immediate focus of attention.    So, after five hours, arm and hand were x rayed and the splint that I had already applied were considered to be adequate treatment for the moment.  Her head was either not noticed or considered to be important, despite extensive bruising and tenderness over the zygomatic bones of the face and a black eye.   I brought her home from the emergency room at University Hospital where she had been sitting for five hours without having been seen by a physician, when she was so uncomfortable that she insisted on signing herself out.   Being a physician I was satisfied that she was not bleeding into her brain.  However, this was not known by the staff and it concerns me that someone whose cognition may have been impaired was allowed to leave emergency without any attempts to assess cognition or to explain the possible risks involved .  Equally unbelievable, was the fact that despite the fact that as Professor and Head of the Department of Family Medicine at the University of Saskatchewan and as a life long teacher of Family Medicine students and Residents I had tried to make my students aware of the fact that they must screen for family abuse, nobody asked my wife if she had been beaten up by her husband or otherwise abused.. No-one ever took an adequate history.

            Next morning, since my wife (understandably!) refused to go back to emergency at University Hospital, and her head had not yet been looked at, other than by me. We went to St. Joe’s Hospital, where the experience was much more acceptable.  The appropriate investigations were carried out and the damage recognized and treated.  In fact, she sustained a maxillary bone fracture.  I have spent much of my life working (and sometimes living) in hospitals and I understand the difficulties that health care workers have to contend with.  Nevertheless this is not good enough, more focus being directed to the documentation than to the patient.    Suffice it to say, that something is amiss in the state of Health Care, that in my opinion is closely related to the deterioration of the conversation between the physician and the patient that all the technology in  the world can't replace.