After my two pre-clinical years at Newcastle, I thought I was well prepared for the clinical years. We had spent many hours on communication skills and I was sure that talking to patients would be a doddle. Introducing yourself? Sorted, after a three hour session. Generating rapport? No problem, I had been videoed doing just this as part of my training and had been complemented on my skills. Ending the consultation? Easy.
So, when I came to third year, I was full of confidence. To be fair this confidence did not last too long. On the first day I arrived in my new suit, looking pretty sharp if I say so myself. On my way into the hospital I thought that jumping a particular fence was the quickest way in. This ended up with me sprawled on the ground, with a large rip in my trousers and blood coming from my knee. However I could not get changed so I had to do my first day looking an absolute mess. Not the best way to introduce yourself to the staff, students and consultants that you will be spending the next year with.
Anyway, back to the patients....
We were thrown in at the deep end early on and we were sent onto the wards to take a history each. My first patient was a lovely 70 year old man with some gastrointestinal problems. I thought I did an OK job at the time, but looking back at my notes now, with a couple of years more practice, the history does look very sparse, with most if not all of the important details missed out. I did take good notes regarding the patient's ICE (ideas, concerns and expectations), a Newcastle favourite, but the past medical history was non-existent.
What I found with the early histories that I took, which followed a similar pattern to this one, was that I was very comfortable with how to talk to patients. All the teaching was useful then. It was the specific medical questions that did not come so easily. The way I got around this was by writing out a basic set of questions for each body system, which if I asked would ensure I would get the most important information from the patient.
Initially, when we took histories from patients we had to go and report back to the education staff. As they were dedicated clinical teachers, they gave excellent feedback and were always encouraging. After a few weeks however we started to give our histories back to the consultants. Now consultants are generally nice, but they are busy people, and they only wanted the necessary information, meaning we had to adapt our skills accordingly.
It can be a little nerve racking taking your first histories, it certainly was for me. What made it easy for me was that every patient I met was extraordinarily nice to me. They were very understanding with my questioning and when I asked my favourite question, 'so, is there anything else you think I should know' they always came up with some important information that I had missed. I also found talking to the patients really interesting, although normally for non-medical reasons. They had often lived interesting lives, and I would find myself chatting to them about this rather than their medical problems.
So, that was my initial experiences of taking patient histories. It took a little time, but after a few weeks I was confident in my skills and happy with my history taking.
Ross McDermott, fourth year medical student (Newcastle)
Received May 2010
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