Submitted by Kultaj Kaleka
Published June 21, 2020
“Ms. O is a 55 year old female, who presents today for a knee injury. She states that she tripped and fell forwards onto her knees while chasing chickens. The right knee took most of her weight. Her pain at point of injury was a 10/10, this improved to 8/10 after she took a Norco. Extending or flexing her knee worsens her pain. X-rays did not find any significant fracture. She would like her knee to be assessed and a prescription for an alternative agent to Norco to help manage the pain.”
For most, the above is a succinct and comprehensive note that elicits all points pertinent to the patient’s condition and care. While obtaining this history however, all I could picture was a kind, somewhat overweight lady in a tie-dye shirt, chasing a chicken just like Rocky in Rocky II. Against all instincts and constraints on time, I had to ask, “What were you doing chasing chickens?” She replied, “Well ordinarily we would be trying to catch them to butcher them, but that day we were just trying to Vaseline their legs.” This response left me flummoxed. The picture it created in my mind put the image of an overweight, tie-dye-wearing Sylvester Stallone chasing chickens to shame.
At this point, I knew I would be spending more than the allotted ten to fifteen minutes to interview and examine this patient. The task of a third year medical student is to master the art of obtaining a comprehensive and coherent patient history. Often, my curiosity and desire to have a good conversation can get in the way of obtaining the salient information quickly and efficiently. But I have also found that there is a certain benefit to straying from the traditional and trusted guidelines for history-taking.
In the dialogue that ensued with my patient, I learnt something I will never forget. Apparently, chickens routinely endure a chase, catch, and Vaseline swathing. Vaseline protects chickens from mites that burrow under the scales of their legs and feed off of keratin on the surface layer of their skin. Smearing petroleum jelly on the mites effectively suffocates them.
Now, my attending clearly wasn’t impressed by the length of time I had taken to elicit this patient history. Incompetent as I am, I had also forgotten to perform a McMurray test for knee evaluation, and couldn’t distinguish between a valgus and a varus strain. She was not amused by my story of the chicken and the Vaseline. I was summarily dismissed with feedback to cease with hemming and hawing and do a better job examining and presenting patients.
As a trainee, I am aware of the many glaring deficits in my practice. I know my attending has good intentions, and I am thankful for her time and consideration in identifying my shortcomings. However, I am also convinced that the patient interview should be valued for more than just its diagnostic worth. Having dialogues with patients, learning about their lives, is therapeutic. Talking about the contexts in which they work, eat, live, and enjoy themselves gives me a better understanding of how to help them. The empathy that comes from knowing another, being able to relate to another, and being able to picture yourself in their position is surely something desirable in the physician-patient interaction. These moments are what I will draw upon as a future physician, on the days when I begin to feel overworked and under motivated.
The factory worker on her feet for 15 hours a day coming in with back pain. The high school student with bulimia trying to cut weight to make the wrestling team. Or the woman who sacrificed her knee for her chickens. A kaleidoscope of organic, human narratives that I will look through to help me recognize the humanity of my patients, who are not just puzzles waiting to be solved but people hoping to be heard. I waved to Ms. O as she left the clinic, confidently and emphatically typing “mechanical fall due to chasing chicken” into her note.
Editor's Commentary
Mr. Kaleka is a third-year medical student at Central Michigan University’s College of Medicine, and a student delegate to the AMA. He aspires to pursue Psychiatry. Prior to medical school, Mr. Kaleka worked as a registered nurse at Mt. Sinai Hospital. Mr. Kaleka enjoys writing about, “Humanism in Medicine”. His previous work on the topic has been published in Academic Medicine and Johns Hopkins’ CLOSLER forum.