Starting Over

Mrs. Jarvis seemed almost exasperated with my questions. She had told me all her symptoms a couple of times and I had asked several follow-up questions. Between our first and second visit she had gone for several tests, but I could not make a unified diagnosis. I was beginning to think she had several things going on, but I couldn’t make sense of her nausea.

“I am stuck,” I said. She sighed as I continued: “I must be missing something in your story.” Then, in a moment of inspiration, I got up from my stool and walked over to the exam room door as she followed my movements with suspicion and disbelief in her eyes.

With one hand on the doorknob I turned toward her and explained what I was doing:

“Pretend I’m an amnesiac and you never met me or told me what you are feeling. I need to hear your story again from the beginning and without interruptions.”

She giggled as I walked back across the room, shook her hand and introduced myself. Her husband grinned from his chair in the corner.

Nausea is a lot like dizziness. I remembered the lecture on dizziness Dr. Martin Samuels had given at a Continuing Medcal  Education course I attended years ago. Dr. Samuels is Professor of Neurology at Harvard Medical School and one of the most captivating lecturers I know.

Don’t ask a dizzy patient any questions, because with that particular symptom, all questions are leading questions. If you ask a dizzy patient a single thing, they’ll say: “yes, that’s what it’s like” and you are doomed, Dr. Samuels cautions.

In order to evaluate a dizzy patient, you need to lean back in your chair, touch your chin, take some deep breaths and look out the window, not at the patient. Then you need to just sit there for a while and finally say: “Dizzy…?” You then must wait as long as it takes for the patient to tell you more.

Mrs. Jarvis smiled as I did my Marty Samuels impression. Her husband leaned forward from his chair.

With renewed resolve to avoid any leading questions that might derail her story, I said in a reflective tone of voice:


Five minutes later, without asking a single further question, I knew what to do.

2 Responses to “Starting Over”

  1. 1 ageing student November 15, 2009 at 6:07 pm

    so…. what was the diagnosis?

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.


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