This website is to help you get your medical story straight. It is a simple tool that I have used for 40 years in my practice to help me listen to my patients
and see patterns in their symptoms that reveal options for steps to promote healing.
Have We Done Everything We Can for this Patient?
Early in my 50 years of caring for people seeking answer for chronic illnesses I found a way of listening that begins with a symptom checklist as part of a long questionnaire with a chronological record of illnesses and life events. Before meeting my patients, I have studied and sorted the checklist by frequency and severity. Our first conversation starts with a mutual grasp of the story with and then consider the options. This approach differs from the way I was trained in two ways. First, it respects the patient as a source of details and second, it considers details that are irrelevant to making a diagnosis but which may be game-changers in making a plan.
I have collected tens of thousands of symptoms from my thousands of patients who have used checklists of nearly 500 symptoms for children with special needs and half that number for adults and children with chronic illness. I have let those data talk to me and to my patients about fundamental issues of biochemistry, immunology, toxicology, and infection. Such issues transcend diagnostic labels. They constitute a short list of well validated options for healing.
When doctors make a diagnosis, we are trying to limit the defining symptoms and lab tests. It’s called diagnostic parsimony. This is a big deal in medicine where the boundaries between this or that disease are taken seriously. At present, there are in the International Classification of Diseases more than sixty thousand such “entities”. Details that have no bearing on picking a diagnostic label may, however, be vital to answering a question I learned in the spring of 1959 from Dr. Edgar Miller; “Sidney, have we done everything we can for this patient?” I heard those words in tiny upstairs weekly clinics in villages of the valley of Kathmandu, Nepal where most of our patients had acute illnesses and injuries. The spirit of the question was conspicuous by its having been thoughtfully spoken in a busy place. The value of the question rises in a more relaxed first meeting with a chronically ill patient, In that place and time missing details can bring risk and regret. In the days of my training the medical record was hidden from the patient’s eyes. Nowadays most doctors will appreciate having a copy of your report to save time and complete the record. As was true for me, you will be surprised by the simplicity of the harvest of actionable options based on analysis of your questionnaire. That analysis begins with my having asked of each of the 500 or so symptoms that describe the whole universe of illness, “What does this symptom tell us about basic problems that underlie chronic illness?” About two thirds of symptoms fall into patterns that can contribute to a plan of action. Certain symptoms can, by themselves, be decision drivers.
