A Medical Economics Web Exclusive

Take this patient’s history–please

There’s plenty of humor in medicine–if you keep a lighthearted perspective. The author’s encounter with "Harry" is a case in point.

By William T. Sheahan, MD
Family Physician/Winter Park, FL

Like many doctors, I’m often stressed out from trying to get through my workday. But some patients inadvertently thwart my attempts to be efficient.

Take Harry. I’d already addressed his medical problem, so when he returned for a checkup I took the opportunity to fill in some gaps in his medical history.

But Harry, 55, was incapable of giving me a straight answer. Our colloquy was more reminiscent of a Marx Brothers routine than a doctor-patient dialogue. At first, I was frustrated by our inability to communicate. Then I began to see the humor in it. When I recount the experience to my colleagues, it cracks them up. See what you think.

Me: You’re married, aren’t you?

Harry: Yes.

Me: Is that your wife in the waiting room?

Harry: No, it’s my lady friend.

Me: I thought you were married?

Harry: I am, but my wife and I haven’t been together for years. We just never divorced.

Me: Well, we should probably test you for exposure to hepatitis C.

Harry: Why?

Me: Because you’ve had sex with more than one partner in your lifetime.

Harry: No, I haven’t.

Me: Didn’t you have sexual relations with your wife and your lady friend?

Harry: You bet I did. But only one at a time. I’ve often fantasized about being in bed with more than one woman, but I haven’t been that lucky.

Me: I’ll just send your blood sample to the lab. Do you have children?

Harry: Not anymore.

Me: Oh, gosh, I’m sorry for your loss. What happened?

Harry: They grew up and moved out.

Me: Oh, I see. How many children do you have?

Harry: By which wife?

Me: Er, how many wives have you had?

Harry: Four.

Me: Four! How many children do you have in all?

Harry: Six. I think. Who can remember? I haven’t seen some of their mothers in quite some time.

Me: Have you ever smoked?

Harry: Yes.

Me: Still smoking?

Harry: Yes.

Me: How much do you smoke?

Harry: A lot less than I used to.

Me: So, how much?

Harry: Hard to say.

Me: Well, on a typical day.

Harry: It depends.

Me: On what?

Harry: On whether it’s a weekday or a weekend.

Me: I see. How much do you smoke on a Saturday or Sunday?

Harry: It depends.

Me: On what?

Harry: On whether there’s a football game on TV.

Me: So if there’s a game on TV, how much do you smoke?

Harry: A lot more than I smoke when there’s no game.

Me: Let’s try a different approach. Do you buy cigarettes by the pack or the carton?

Harry: Carton.

Me: How many cartons do you buy a week?

Harry: I don’t buy a carton every week.

Me: So you smoke less than 10 packs a week?

Harry: I don’t think so.

Me: If you don’t buy a carton every week, you must be smoking less than 10 packs a week, because there are 10 packs in a carton.

Harry: I see what you’re getting at. I meant that I don’t have to go to the store every week. When I do go, I usually buy more than one carton at a time.

Me: How many cartons do you typically buy?

Harry: It depends.

Me: On what?

Harry: On whether or not there’s a sale.

Me: Okay, on a typical weekday, how many cigarettes do you smoke?

Harry: I’m not sure. You see, I don’t always smoke the whole cigarette. And now I smoke a light brand. So that doesn’t count as much as smoking a regular cigarette.

Me: Well, take a wild guess. A pack a day? Two?

Harry: Sure, I suppose, if you must write something down. But I really have no idea.

Me: Let’s move on. Do you ever drink alcoholic beverages?

Harry: Sure, but I haven’t had a drink in quite some time.

Me: Good for you. When did you quit?

Harry: I didn’t say I quit.

Me: How long since your last drink?

Harry: It’s been at least a couple of days.

Me: How much do you typically drink a day?

Harry: I don’t drink the hard stuff–only beer.

Me: How much beer a day?

Harry: It depends.

Me: On what?

Harry: On whether there’s a football game on TV and my buddies are there to watch it with me.

Me: Well, if there’s a game on, and your buddies are over, how many beers do you drink?

Harry: More than if I’m watching alone.

Me: Let’s try this: How many cases of beer do you buy a week?

Harry: I don’t buy cases every week.

Me: Oh, right. You probably buy more than one case at a time if there’s a sale.

Harry: Actually, I never buy cases–only six-packs and 12-packs.

Me: Do you normally drink a six-pack a day?

Harry: If you must write something down, I suppose that will do. The truth is, sometimes I drink more, sometimes less.

Me: Well, that’s enough history-taking for one session. How about I give you a flu shot?

Harry: No thanks. Every time I get a flu shot I come down with the flu.

Me: When was the last time you had a flu shot?

Harry: Oh, 1976 or thereabouts.

Me: It’s up to you. Have you been taking those blood pressure pills I prescribed the last time you were here?

Harry: Most of the time. Sometimes I forget.

Me: According to your chart, your last refill was for 30 pills. That was two months ago.

Harry: Really? No wonder I have no more left. I took the last one just before coming here. You know, going to the doctor can be a nerve-racking experience.

William Sheahan. Take this patient's history--please.

Medical Economics

2001;12.