Time, reflection and history

Time and the importance of stories have been on my mind lately. As students, we were told: 85% of your diagnosis comes from the history --the patient's account of his symptoms and experiences. Although I have no journal citation for this pearl, it reflects the centrality of the history to the practice of medicine. The telling and exploration of the patient's story not only gives information which may lead to a diagnosis (although this is certainly important), but serves as a source of connection, understanding and healing. (N.B. I owe a good deal of what I know about Thomas and Percy, several WWII battles and the Raffles Hotel to these histories.) A good story takes time: to tell; to listen; to respond; and to reflect upon its meaning. When all goes well, the patient's narration and our subsequent discussion tell me her experiences, priorities, situation, environment and goals. I am then able to facilitate her understanding of the possible explanations of her experiences (a differential diagnosis) and together we work out of plan to move forward towards those goals. For me, this is not the work of 15 minutes.