On December 6, 2012, the Government of Ontario announced the latest initiative in its goal to “better coordinate the full patient journey through the health system”. This initiative is called Health Links. At the Government of Ontario website that describes the program, it is noted that one of the governments goals is “to ensure that patients with complex conditions no longer need to answer the same questions from different providers”.
As a consultant for patients with complex mental health conditions, my concern is that I rely on the history I obtain from a patient to formulate a diagnosis. In taking this history, I am usually asking that they answer the same questions that others have already asked. It is worrying that this part of my assessment is so poorly understood by the Government of Ontario that it seeks to discredit this valuable diagnostic tool.
A patient’s own description of a pain, a feeling or the timeline of an illness can be key to diagnosis. These descriptions constitute the symptoms of an illness and most medical textbooks put a strong emphasis on the value of taking a complete patient history and even of copying down some of the patient’s symptoms in his or her own words. The dialogue involved in taking such a history not only provides information, it also fosters a relationship between a doctor and a patient.
Herein lies the key to good healthcare – a patient who knows and trusts a doctor will seek out their assistance before a health problem becomes serious. A doctor who has a relationship with a patient, who has known him or her for many years, will often be able to recognize a health problem sooner.
The most compelling reason for continuing to take a complete history from a patient, even if I am asking some of the same questions that others have asked, comes from Sir William Osler’s often quoted reminder to his colleagues and students: “Listen to the patient. He is telling you the diagnosis.”
Even though the designers of Health Links believe I am having unnecessary conversations, I think I will still take Osler’s advice – so far no patient has minded.