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What medical problems do you have?

When I ask this question of patients in the ER, it's amazing how often they forget to tell me about serious diseases that completely change the way I want to treat them. It happens so often, in fact, that I'm tempted to say this to all my patients when I first walk in the room:

"Tell me what medical problems you have. And tell me everything. I'd better not go out there and look you up on the computer and find all sorts of shit that you haven't told me about. I want you to come clean with me now. If you have diabetes, you'd better just tell me now and get it over with. Because I'm going to find out, one way or the other. And if I find out that you're a diabetic or that you have lupus or some shit like that and you haven't told me, I'm also going to assume that you also have dementia, or that you've been sniffing glue."

Of course, all of this is (somewhat) in jest. I'm lucky enough to be a healthy person; I can tell you all the medical problems I've ever had since I was born, mostly because there's been so few of them. I had ear infections. I had an effusion in my knee once. I've had intractable vomiting from eating bad refried beans at a disreputable mexican restaurant in Sedona. I remember all of these things because they're so unusual.

But I suppose that if I had diabetes, or lupus, and I'd been living with it for years and years, I might forget to mention it when I went to the ER. Maybe. Assuming, of course, that I was also hypoxic or hypoglycemic or high from breathing the fumes from a tube of Krylon spray paint.



HMMMMM....sounds like Dr. House! He gets away with it, why can't you??? Wouldn't bother me if a Doc asked me that.

Sounds like an argument for a Big Brother chip imbedded in everyone with all their personal health information; or, better, electronic access to everyone's PHI among the numerous hospital systems throughout the US. You've hit the nail on the head, though - people so used to their ailments they don't think to mention them, along with the nervous-can't think factor of being in the emergency room. Of course, that doesn't take into consideration all the people who use the ER as their PCP - but then that's "a whole nother topic."

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