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Medical Humanities

History Taking Tips from Grandma

May 30, 2018

I learned how to take a proper medical history from my grandmother.

Ralph, the shy boy who lived across the street from me, came over one day to teach me how to rollerblade. Within moments of ringing the doorbell, my grandmother greeted him with a cup of tea in one hand and Mauritian treats in the other. In her wobbly English, she started with her innocent probing: “Have you eaten? Which house did you say you live?”  I witnessed Ralph, the silent ninth grader who had a monochromatic emotional repertoire, open up and start talking. By the end of the conversation, Ralph and my grandmother had shared a meal, giggled together over his big sister’s bad cooking, and reminisced about their experiences at their immigration ceremonies. Leave it up to my grandmother to unveil your hobbies, family history, and recreational drug-use all before taking off your coat.

Somehow, I never inherited this impressive interpersonal gene. It must have skipped a generation, because as a first year medical student, I turned to my clinical skills handbook to learn how to connect with people.  I don’t think many students like to admit this, but I truly had to learn from a textbook how to talk to people about their intimate lives. “Ask open ended questions,” it says. I sat down beside the patient at eye level as to not be intimidating, tilted my head 45 degrees, smiled at appropriate times, and nodded at a frequency of 15 hertz.  I was terrified at the thought of having people disclose details about incredibly intimate secrets about their personal lives. I was crossing into foreign territory, and it showed in my clinical performance. In fact, one piece of feedback I received from a preceptor was to “blink more,” as my stare gave the appearance of a robotic interrogation. I had forgotten to plan my blinks that day, but the next clinical encounter I came prepared with my head-tilt, 15 hertz head nod, and periodical blinks at a tempo that convinced the patient that I was, indeed, human.

I was twenty-one when I was accepted to medical school, the same age that my grandma was already living on her own in a small town in Mauritius, my family’s home country. One particularly memorable story of my grandma was back in the ‘70s when a devastating cyclone that ravaged the country. She ran to my great uncle’s house that was miles away to get help. Together, they literally held the roof of their house down with rope. I’m not sure which I am more baffled at – the fact that they held down an entire roof with (what I imagine were their bare hands), or the fact that she was able to make the trek out to my uncle’s house in a pre-Uber era. The point is, she was always a street-smart lady who has seen a lot in her lifetime, and was always adaptable even in times of great adversity.

A few years later, my grandma opened her own small grocer in her small town. Being a shopkeeper requires remarkable interpersonal skills. From the shoplifters of Rosehill to the housewives of Port Louis, my grandma knew how to talk to anyone. She knew how to connect with people just by virtue of being interested in who they were as a person. She knew how to de-escalate a situation when clients were unhappy or disappointed. She always remembered her regular customers and what they liked to order. She made people feel at home and listened to.  These skills were not memorized from a textbook; they are unspoken lessons drawn from everyday interactions from her living in a small community where people helped each other in simple ways. When your friend got sick, you came over and lent them a hand with the housework, no questions asked. When your neighbor was angry because of the overgrowth of your coconut tree into their backyard, you listened to what they had to say and made compromises. When you lose you child, you learn how to help other mothers through their grief. These are meaningful experiences that enrich our understanding of how to care for a person at their most vulnerable.

These days, my patient encounters are more candid, with slightly less of the clinical coldness I once hid behind. During my infectious disease rotation, one piece of information we routinely ask is their date of immigration. To my surprise, every patient I met remembered the exact date that they landed, without any hesitation. Curious, I asked one of the patients on the ID wards why this is. She responded: “Of course, how can you forget the day when you moved away from your home, family and friends to start a new life?” Tears formed in her eyes as she continued, “It is like coming here in the hospital. You never forget not being at home.”

For the first time in my life, I felt like my grandmother, the shopkeeper behind the counter. In this intimate conversation, I learned that hospitalization, is, in many ways, similar to immigration. People migrate from their homes into a new space, and part of our role as physicians is learning the art of making people feel at home in foreign and uncertain environment. This task has never been easy, but patients teach me everyday what they need in times of tragedy. I look back on this first year of clerkship, and I am truly amazed to have met so many people from diverse walks of life, helping me to gain insight into the rich and colourful lives that they live. No longer are the days of stiff, clumsy interactions; instead, I look broadly at the bigger picture rather than dissecting every movement, or miming every phrase that gives off the appearance of a well-intentioned clinician. We do not need to puppet the phrases we read in clinical textbooks that make us appear like we care. If we are curious and respectful, we will ask the right questions. Authenticity can go a long way in making patients feel at home, even when they are far from it.

My grandmother never went further than an elementary school education, yet her ability to make people comfortable enough to divulge their life histories would impress the most experienced doctors. The thought often crosses my mind, that perhaps, if she was born in a different place and time, I know that she would make a phenomenal physician.  Much of what I had learned in my clinical classes were basic life skills that my grandma intuitively knew just by virtue of listening, caring and being attentive to her community. As my grandma always reminds me about patient care: invite people to sit down, ask if they have eaten, and let them tell you where they have been, where they plan to go, and what you can do to help them on their journey.


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