Blog | Tuesday, September 3, 2019

The danger of assuming


Recently I have spent much time listening to linguistic podcasts. They have triggered many thoughts about how we take histories from patients. Linguistics represents a very complex science of language.

One concept that has intrigued me involves the meaning of words. When we hear words or read words, we automatically assign a meaning to those words. Too often, especially when we are students and residents, we make assumptions about meaning. However, with experience we learn that words mean different things to different persons.

Experience teaches us that certain words have different meanings amongst patients. Thus, we have to practice our questioning skills to determine the story with precision. Some examples that come to mind include: diarrhea, pain, weakness, shortness of breath and dizziness. Patients often use these words to describe their symptoms, but further questions reveal a wide variance in their meaning of the words.

For example, when a patient claims diarrhea, we should not start ordering tests without further characterizing the symptoms.

Learn to not make assumptions from the words patients use without spending the time to further specify the symptoms. Assuming definitions without clarification will often lead to over-testing or misdiagnoses. While it takes precious time, we have a responsibility to understand what is bothering the patient. We should not assume that we know just from single word complaints.

db is the nickname for Robert M. Centor, MD, MACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and the former Regional Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds regularly at the Birmingham VA and Huntsville Hospital. His current titles are Professor-Emeritus and Chair-Emeritus of the ACP Board of Regents. This post originally appeared at his blog, db's Medical Rants.