I was by then a senior paediatric registrar, two years from becoming a consultant and equipped with good levels of skill and knowledge.聽Even so, I still experienced anxiety as I arrived for a night shift on the 鈥渟pecialities鈥 side in the tertiary hospital: the fear of the unknown at what might be waiting for me at handover causing a familiar sense of unease to manifest itself in my physiology.
On this occasion, however, handover was swift and smooth and a speedy saunter round the wards confirmed the patients did indeed have plans and were stable.聽Even the oncology wards did not require an extended period of fluids and electrolyte prescriptions and no one was 鈥減oorly bad鈥.聽With the bonus of an experienced and friendly Senior House Officer to share the shift, I thanked the on-call gods and congratulated myself on my choice of snacks and the book that I had remembered to bring, and settled into the most comfortable position one can in a plastic chair.
The bleep went off.聽I liked the neurology consultant. She was clever, experienced and kind.聽I am sure we would have been pals at medical school had we been there at the same time. 10:30pm was a standard time for an 鈥渙ff to bed鈥 check in from some consultants, but this was not the standard call: 鈥淐hris, I know it鈥檚 not busy so I鈥檝e got a job for you.鈥 I will be honest and say my heart did not leap with enthusiasm.
Dr F then described in detail the history she had taken from a new patient* 聽transferred from a district general hospital after a respiratory arrest. He had seen multiple staff members locally and in the tertiary centre before her, but she had invested a substantial amount of time in going through the history in detail and eliciting some symptoms that had not been picked up previously. She told me he must have a syndromic diagnosis and I would have time to use the books/internet to figure it out by morning when she would expect an answer.
Happily for me, five minutes later Dr Google had made the diagnosis. The right phrases entered into the search engine linked to a paper from London with a case series of a dozen or so children with a relatively recently described syndrome. This patient met the diagnostic criteria and I printed the paper out for his notes and returned to my book feeling fairly smug.
I know that it is essential to allow parents and young people the time and space to tell their story and for me to listen actively and intently, without interrupting
How can a GP be expected to take a history in this ideal fashion during 40 plus 10-minute appointments each day?聽How can I do it during a 12-patient paediatric clinic?聽Can we support patients and parents to realise the importance of their story? Can we say in the appointment letter that the story of their illness is far more useful than any investigations I could arrange and how helpful it is to reflect on their illness and prepare what they want to say before their appointment? I know I do this for my health appointments. Why do doctors sometimes forget just how important the patient story is?
The question聽I am left with is: does the time and space exist in modern healthcare systems to allow a proper history to be taken?聽 And if not, how do we design it back in?
Dr Christopher Bidder is a consultant paediatrician in Swansea Bay UHB with a special interest in diabetes and endocrinology. 聽He enjoys trail running, paddleboarding and beach fire cooking on Gower.
- *Any information that could identify someone has been changed