Health and Psychology

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Taking a history

Posted by Margaret Donohue on October 25, 2015 at 11:15 AM

I listened carefully as psychologist Anthony Zamudio, Ph.D. spoke at the 27th annual Convention of the Los Angeles County Psychological Association about his clinical practice within a primary care clinic.  He sees 30 to 50 patients a week in 30 minute intervals.  Not what I do.  He has patients he treats for psychological factors that impact physical conditions.  I see no more than 15 people a week.  I spend 50 minutes to 2.5 hours getting a history.


When I first started in practice in a medical office, my clients were depressed and anxious with some weird medical symptom that defied diagnosis.  They were frustrated as was the physician.  It was my job to assit the patient in describing their symptoms adequately so the medical condition could be illuminated.  Cancer, endocrine disiorders, rare medical conditions, and heart disease were the commonly missed diagnoses. The idea was that by taking an adequate history in addition to noting physical symptoms the physician could cut down on unneeded tests and avoid litigation for failure to diagnose.  Most people talk about medical symptoms in non-medical terms.  There is then a problem with the translation of patient language to doctor language.  So a woman comes in saying her neck hurts.  The physician gives her a prescription for ibuprophen.  She comes back saying her neck is worse.  I would then see her.  She's been cleaning her shower on her hands and knees.  She's been moving furniture.  Her son is coming for a visit.  She cleans the shower for a bit then her neck hurts.  She can no longer clean her shower. After 20 to 30 minutes of lying down covered in sweat, the pain subsides.  When she goes back to clean the shower it starts back up.  She's nausous from the pain.  I tell the physician she needs an EKG a way to check the electrical activity of her heart.  The heart attack has already occurred and she's at risk for another one.  She has an 99% occluded blood vessel found on angiography at the hospital.  At the end of the day I review the case with the physician.  So he can see what I saw for the future.  Her coloring is ashen.  There's some mild bluing as an undertone. She's laboring to breathe.  Her jaw is tight.  She never mentioned sweating or nausea so the physician wasn't cued to look for heart problems.  She talks about neck pain, but holds her hand up to her throat first before reaching around to the back of her neck.  She arches her neck slightly to take a deep breath.   Physician's still think of chest pain, which is a common presentation in men with heart attacks. Women are more likely to complain of feeling sick and maybe having the flu, or neck pain, or feeling weak or tired.  But symptoms increase on exertion and lessen on rest. If the information isn't provided the physician can't know what's going on.  


If you are having a problem getting diagnosed for your recurrent symptoms, contact our office.  818-223-4116.


 



Categories: Health Psychology, Diagnosis

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