Write Your Own History

Any doctor will tell you that the first step to making the proper diagnosis is taking
a good history. Taking a patient’s history is an art that is learned in medical school
and practiced over and over again. Writing your own history may give you clues to
your own diagnosis and would be useful to any specialist you’re planning to see.

Step 1:
Symptoms: List all your symptoms as concise and succinctly as possible without
using medical terms. Give the start date, frequency, duration of episodes and
severity. List the most bothersome symptoms first, but don’t forget to list
symptoms that don’t seem like a big deal as they might provide clues to the
diagnosis. When do symptoms occur? Morning, night, before or after meals, at rest
or with activity? If you have more than one symptom, do they occur together or
separately or one after the other? Do they start gradually and progress or start
suddenly? All these things can provide clues to the diagnosis.

Step 2:
Response to Medications: How you respond to medicines; which ones help
and which ones are useless provide clues to the diagnosis. For example, if you
have chest pain and Tums helps, you probably have acid reflux. If inhalers don’t
help, it’s less likely to be asthma. List all the medicines you’ve ever taken and the
dose if you can remember. Then list whether they helped or not and if they had any
side effects. Pharmacy’s keep logs of all the prescriptions you fill. Ask for a print-
out to remind you of all the medications you’ve taken in the past.

Step 3:
Social History: Things like smoking, drinking, and occupational exposures
can provide clues to diagnosis. Sleeping habits, stress and diet may be part of
certain conditions.

Step 4:
Family History: Many conditions have a genetic component or are
genetically linked to other diseases. For example, some families have autoimmune
tendencies with several family members having them.

Step 5:
Past Medical and Surgical History. All past conditions may provide clue to current diagnosis.

Objective Findings: List anything a doctor has ever detected on
examination such as a heart murmur, abnormal lung sounds, or anything else.

Step 6:
List all Test Results: List the abnormal results first, but normal results can
be just as important. Make sure to keep a file of all your results. Ask your doctor
for copies of all tests and call prior doctors to request records. Keep a file on
yourself. It’s much easier than expecting your doctor to chase down all your old
results.

Step 7:
Differential Diagnosis: List all the diagnosis’s that your doctor(s) have
suspected. Even if it’s a wrong diagnosis, you should still list them. Medical
textbooks and web sites on particular conditions often have a section called
“Differential Diagnosis” where they list all the conditions which mimic that
diagnosis and, therefore, one of those diseases might actually be the correct
diagnosis.

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Finding the Right Doctor:

The best doctors for mystery illnesses are at universities. These doctors are not
necessarily any smarter than those in private practice, but they are usually more
experienced in dealing with unusual conditions. Universities also have the
advantage of having several physicians working together as a team. Difficult cases
are often presented at conferences where many specialists can voice their opinions.

Be careful about doctors who only specialize in a single condition as they often
overdiagnosis their disease. This is especially true of doctors in private practice
such as “Lyme disease specialists” who diagnosis all their patients with Lyme
disease. On the other hand, a good primary care physician could be very useful in
directing care and pointing you in the right direction.

Science is important even if not all answers are known. Stick with physicians who
practice evidence-based medicine. Thinking “outside the box” can be helpful, but
if you refuse to look in the box, you may be missing an easy diagnosis.

Look to the medical literature. Doctors who have published articles on a particular
condition, or symptoms or unusual blood results may have knowledge that others
do not. Do literature searches on Pub Med or Google School and contact the author
if you think the article pertains to you. I find the service “Up to Date” particularly
useful, if you’re willing to pay for it. Typically, the author for any particular
section, is the national expert on that condition and would be a great person to
make an appoint with. They have sections for every condition and sections on
approaching patients with certain symptoms or abnormal tests.