At medical school we were always told that there is no such thing as a patient who is a poor historian just a poor history taker. With this doctrine still ringing in my ears in Cambodia I thought that it was just my extremely poor language skills & things getting lost in translation, which gave me the impression that Cambodian patients are really dreadful historians. I have recently had to revise this opinion.
My khmer teacher, S, who speaks reasonably good english & is an educated woman asked me for some medical advice. In khmer she told me she had a sore throat.
How long for? I enquired.
Since you left for Sampov Luon - came the reply. So this was about 6 days.
Where is it sore exactly?
THROAT! she shouted as me in khmer.
All over, one side, upper, lower???? Could she maybe point to the place? I persisted
Silence & a very blank stare. So I asked again but this time in khmer. Still a blank stare. So I demonstrated pointing to either side of the throat on the outside, then opened my mouth & pointed to my tonsils & finally pointing outside but lower down, by my sternal notch.
THROAT! she yelled at me in khmer again. It is not uncommon for patients to present with unspecified character of pain "choo" all over their entire body so I should perhaps have been grateful we had an area.
What brought the pain on? I asked her, changing tack slightly. Have you had a cough or fever with it? Can you swallow ok?
NO NO NO! she shouted back at me & then disappeared into my bathroom.
She came out a few minutes later & flipped her head back like a cartoon character, opening her mouth in such a way that all could I see was the roof of her mouth & her false teeth.
THROAT - she yelled in khmer at me whilst performing a semi-limbo for me to inspect her dentures. Well at least I could surmise she had an airway, was not hoarse & at 63 years of age was still very nibble.
I felt for swelling or lymph nodes in her neck - she shrugged me off - THROAT! she screamed at me.
Using another favourite history taking trick of mine & the very last of my patience I asked her what she thought the problem was?
"I ate some fish & the next day I had a sore throat, maybe I scratched my throat" she responded in perfect english.
Which side? I asked
She stared at me impassively.
Normally when you get a fish bone stuck or scratch the throat it will be sore in one particular place that people can point to from either in or out side.
THROAT! - she replied......
I have a theory that because in the UK even child birth is medicalised any woman having a baby will have some access to antenatal & prenatal clinics & medical care. Most children are immunised & there are scheduled follow ups for children with community health. Doctors used to go into schools. Dental & optician services used to be provided for free. All of this meant that even if you were a perfectly healthy individual you would still have some contact with free health care services & health surveillance programmes. This meant you became practiced in the questions health workers usually asked. There is health promotion & education in the media, medical dramas & documentaries on the TV all of which provide the language to communicate with health workers. Parents teach their offspring.
Doctors & nurses in the UK talk to patients & depend on their answers to help them make a diagnosis. If you speak to a doctor in my country or ask them a question generally they don't yell at you, tell you to leave there clinic & refuse to treat you again, generally not......
So although I do agree that it is up to a doctor to get a history from their patient there is also something within certain cultures that trains patients to be better historians. Mainly I believe that this is as a result of a decent & robust public health system & professional health workers.
S went to get coined the following day & now feels much better. She is still unable to pin point for me where exactly her pain was but since it has disappeared I thought it was best just to let that one drop.
My khmer teacher, S, who speaks reasonably good english & is an educated woman asked me for some medical advice. In khmer she told me she had a sore throat.
How long for? I enquired.
Since you left for Sampov Luon - came the reply. So this was about 6 days.
Where is it sore exactly?
THROAT! she shouted as me in khmer.
All over, one side, upper, lower???? Could she maybe point to the place? I persisted
Silence & a very blank stare. So I asked again but this time in khmer. Still a blank stare. So I demonstrated pointing to either side of the throat on the outside, then opened my mouth & pointed to my tonsils & finally pointing outside but lower down, by my sternal notch.
THROAT! she yelled at me in khmer again. It is not uncommon for patients to present with unspecified character of pain "choo" all over their entire body so I should perhaps have been grateful we had an area.
What brought the pain on? I asked her, changing tack slightly. Have you had a cough or fever with it? Can you swallow ok?
NO NO NO! she shouted back at me & then disappeared into my bathroom.
She came out a few minutes later & flipped her head back like a cartoon character, opening her mouth in such a way that all could I see was the roof of her mouth & her false teeth.
THROAT - she yelled in khmer at me whilst performing a semi-limbo for me to inspect her dentures. Well at least I could surmise she had an airway, was not hoarse & at 63 years of age was still very nibble.
I felt for swelling or lymph nodes in her neck - she shrugged me off - THROAT! she screamed at me.
Using another favourite history taking trick of mine & the very last of my patience I asked her what she thought the problem was?
"I ate some fish & the next day I had a sore throat, maybe I scratched my throat" she responded in perfect english.
Which side? I asked
She stared at me impassively.
Normally when you get a fish bone stuck or scratch the throat it will be sore in one particular place that people can point to from either in or out side.
THROAT! - she replied......
I have a theory that because in the UK even child birth is medicalised any woman having a baby will have some access to antenatal & prenatal clinics & medical care. Most children are immunised & there are scheduled follow ups for children with community health. Doctors used to go into schools. Dental & optician services used to be provided for free. All of this meant that even if you were a perfectly healthy individual you would still have some contact with free health care services & health surveillance programmes. This meant you became practiced in the questions health workers usually asked. There is health promotion & education in the media, medical dramas & documentaries on the TV all of which provide the language to communicate with health workers. Parents teach their offspring.
Doctors & nurses in the UK talk to patients & depend on their answers to help them make a diagnosis. If you speak to a doctor in my country or ask them a question generally they don't yell at you, tell you to leave there clinic & refuse to treat you again, generally not......
So although I do agree that it is up to a doctor to get a history from their patient there is also something within certain cultures that trains patients to be better historians. Mainly I believe that this is as a result of a decent & robust public health system & professional health workers.
S went to get coined the following day & now feels much better. She is still unable to pin point for me where exactly her pain was but since it has disappeared I thought it was best just to let that one drop.
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