Month: January 2013

Changing the way we present our chronic disease patients.

Old habits are hard to change.

We teach our medical students to recite the following preamble, when presenting a patient.

Mrs. Jones is an  __  year old female with a “Past Medical History” of x,y and z.

This was drilled into my head in medical school and residency.

If I didn’t preface my patient presentation with this statement and information, venerable attending physicians would give me scornful looks and senior residents would take me aside after rounds to correct my mistakes.

I realize why this information is important. Knowledge about the patient’s medical conditions can help frame the visit and symptoms. It guides our thought process.

But the actual term “Past Medical History” serves no meaningful function and we need to stop teaching our medical students and residents to present their patients with this vestigial term.

We practice in the era of chronic disease where conditions like obesity, diabetes, kidney disease, coronary disease, copd (just to name a few) are the greatest public health threat. It’s time we change the language of medicine to properly reflect the gravity of the situation.

Advocacy for this immense public health problem requires that we talk about it as much as possible. It requires that it remain in our consciousness at all times.

When our medical students and residents present Mrs. Jones, they should stop using the term “Past medical history,” Her story needs to begin as a “Chronic disease patient.” Such a description sets the tone for her entire care team that is is a complex patient, that will require broad patient centered clinical acumen. It let’s everyone know that this patient IS modern medicine and the ability to manage her is a challenging and gratifying process that defines what it is to be a physician.

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