Patient As Medical History

If you read my placeholder blog last week, you know that I had shoulder surgery less than two weeks ago to fix a tear in my rotator cuff.  The surgery went fine, and I'm continuing the long, fun process of healing (strapped into a shoulder sling for six weeks, so these blog posts will be dictated for the near future–please forgive slips of formatting and speech-to-text recognition.  Oh, might as well ask you to forgive slips of the brain while I'm at it).

This experience offered no shortage of blog topics, including my favorite genre of the moment, the get-well card. 
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One thing I’m most struck by in this entire medical project is how it seem like two different experiences--the one I had with the people, and the one I had with the forms.

Almost all of the people I had contact with were friendly, warm, just plain nice. I kept commenting on how nice everyone was. But why did that deserve a comment? Why was that so surprising? After all, these people are helping me during a painful time. Why wouldn't they be warm and supportive?

Of course, one response has to involve the whole current medical system in the US, with increasing bureaucracy and often overworked professionals. But I want to bring that general systemic issue down to one place where it becomes so visible–the patient medical history form.
 
You’re all familiar with this form, I’m sure, even if you’ve never paid attention to it. Before you ever see a doctor or nurse, you fill out pages worth of information. 

The patient medical history form was my  first contact with the specialist's office that led to my surgery, after making an initial appointment.  Although the one I filled out isn’t publicly available, all the patient medical history forms are variants on the same thing.

Fill out many pages of detailed facts about​

• Your name, birth date, gender, address, contact information
• Person to contact in case of emergency, including address, phone number, and relationship
• Medications you’re taking, including name, dosage, frequency
• Any allergies
• History of smoking, drinking, and other drug use
• Any surgeries you have had, for what, and when
• Every possible disease or disorder you might have now or might have ever had
• Every possible disease or disorder any immediate family member might have now or might have ever had
• And possibly more!

The list of diseases and conditions you have to check off can run for pages. Certainly dozens are listed, from asthma to tuberculosis. Doctors offices now commonly send you the form to complete online or ask you to arrive at your first appointment 15 minutes early just to fill out the form.

So what’s the first relationship you establish with the doctor and the staff? You are a combination of medical facts and information, diseases and medicines, genetic predispositions, and past  behavior. The Johns Hopkins form I showed above may be a bit unusual in that it asks for your present symptoms, but even then it wants the facts and only the facts, ma’am. 

And don’t forget that in the US the next contact with the office will be handing over your insurance cards and filling out and signing insurance forms.
 
No wonder it’s a surprise when the people turn out to be warm, supportive, and nice. By the time you see them, you've forgotten human beings are part of the picture. You’ve been reduced to medical facts, a body rather than a person with feelings, emotions, and even pain. Any human contact now has to fit into the relationship the patient medical history form has already established.  And it matters which relationship gets established first.

No wonder I felt such a sharp contrast between the relationships established by the people I dealt with and the relationship established by the forms I dealt with.

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In some ways, of course, this depersonalization is nothing new to anyone who has paid attention to today’s increasing bureaucracy of our medical system.

In a review essay written for the Atlantic, entitled "Doctors tell all – and it's bad," Meghan O'Rourke discusses her own experiences with and several books written by doctors about the flaws in our medical system. She points to the lack of attention to human patients, among other things. 

“Ours is a technologically proficient but emotionally deficient and inconsistent medical system…”

And in some ways, of course, the patient medical history form makes perfect rhetorical sense. The doctor and staff get the information they need in the most efficient way possible. But that form could make sense in other ways and could establish different relationships.

Imagine if it asked 

• How are you feeling?
• In your own words, tell me why you are here
• What are you most worried about or afraid of?
• What questions do you have?
• How do you prefer to get information–orally, in pictures, or in writing?

Those questions could makes sense on an introductory form, too, and they would establish a very different relationship before the people meet each other face-to-face.

I first noticed the gaps in the patient medical history form when I was working with my colleagues, Anis Bawarsh and Mary Jo Reiff, on our textbook Scenes of Writing, and we critiqued this genre for ignoring the patient's feelings. Perhaps it's because I was in pain myself that I noticed this time the conflict between what the documents were doing and what the people were doing.

​In the end for me, I suppose, the warmth of the people won out. But wouldn't it be nice if being nice and warm and supportive came first and the medical facts fit themselves into that established human relationship?

So I end with my current favorite genre, addressed to the current US medical system

Get Well Soon, ArtsyBee, pixabay