Finding Out Who the Patient Is

Portrait by Norman Rockwell

If you want to identify me, 
ask me not where I live, 
or what I like to eat, 
or how I comb my hair, 
but ask me what I am living for, 
in detail, 
ask me what I think is keeping me 
from living fully 
for the thing I want to live for. 
~ Thomas Merton from My Argument with the Gestapo

As a patient waiting to see my health care provider,  I would adapt Merton’s template of personal revelation this way:

If you want to know who I am,
ask me not about my insurance plan,
or what is my current address,
or whether I have a POLST on file,
or whether I have signed the Notice of Privacy Practice,
or whether I’ll accept a message on my phone —
but ask me what I am most concerned about,
in detail,
ask me what I think is causing my symptoms
and what I think is keeping me
from eating healthy, exercising regularly,
and choosing moderation in all things
so that I can live fully
for the thing I want to live for.

As a physician in the midst of a busy clinic day, I struggle to know who my patients are beyond their standard medical history and demographics.  One of my goals in our primary care clinic, now sixteen years into electronic medical record (EMR) use,  is to create a way for our patients to provide their personal history online to us via their password secured web portal.   These are the questions our clinic staff may not have opportunity to ask or record during clinic visits.  Having the patient personally document their social history and background for us to have in the chart –in essence, telling us their story in their own words–can be very helpful diagnostically and for individualizing the best treatment approach for each unique individual.

There needs to be an “About me” section in the EMR that would contain biographical and personal history information the patient could provide online via writing or video.

Tell us about yourself

This is your own personal history in your own words to be added to your electronic medical record in the folder “About Me”. You can edit and add information at any time via this secure patient portal to update it.

We want to know your story.  Only you can tell us what you think is most important for us as your health care providers to know about you.  We may not always have the time to ask and document these detailed questions in a brief clinic visit, so we are asking for your help.  

Why do we want to know your non-medical background as well as medical background?

We evaluate a patient’s symptoms of concern but we also are dedicated to helping our patients stay healthy life long.  To assist us in this effort, it is very helpful to know as much about you as possible, in addition to your past medical history.   It is crucial also to understand your family background and social history.  We want to know more about your personal goals, and what you think may be preventing you right now from living fully for the things you consider most important to you. 

This is your opportunity to tell us about yourself, with suggested questions below that you can consider answering.  This information is treated as a confidential part of your medical record, just like all information contained in your record.  You can add more at any time by returning to this site.

1)      Tell us about your family—who raised you and grew up with you, and who currently lives with you– including your racial/ethnic/cultural heritage. If relevant,  tell us whether you have biological beginnings outside of your family (e.g. adopted, egg donation, surrogate pregnancy, artificial insemination, in vitro fertilization)    Provide information on any illnesses in your biologic family.

2)     List the states or countries you have lived in, and what countries outside the U.S. you have lived in longer than a month.  Have you served in the military or another government entity, like the Peace Corps?

3)      Tell us about your educational and job background. This could include your schooling or training history,  paid or volunteer work you’ve done.  What are your hobbies, how do you spend your leisure time, what are your passions and future goals.  Where do you see yourself in ten years?

4)      Tell us about your sexual orientation and/or gender preference.

5)      Tell us about your current emotional support system—who are you most likely to share with when things are going very well for you and especially when things are not going well.

6)      Tell us about your spiritual background,  whether you are part of a faith or religious community and if so, how it impacts your life.

7)       Tell us what worries you most about your health.

8)      What would you have done differently if you could change things in your life?  What are you most thankful for in your life?

9)      What else do you feel it is important for us to know about you?

Thank you for helping us get to know you better so we can provide medical care that best meets your unique needs.

As our clinic is moving to an updated EMR, I’m interested in hearing feedback from patients and health care providers.  What additional questions would you want asked as part of personal history documentation in a medical record?

Electronic medical records allow us, as never before, the ability to share information securely between patients and their health care providers.
Patients want to tell us their story and we want to know more about them. 

It is time we asked them and truly listen to what they have to say.


8 thoughts on “Finding Out Who the Patient Is

  1. Accurate. Every word.
    I can personally attest after several weeks in hospital, including triple bypass surgery,
    that these observations exist. Especially annoying are the so-called ‘hospitalists,’
    who resemble a middle management system that very much resembles lab mice
    in a maze. They do not know the patients and the patients do not know them. Many
    have seriously bruised egos, earn much less than their counterparts on staff. Not a
    happy situation. Guess who pays for this in terms of patient care?
    You will not see nor hear from your Primary Care Physician for the time that you
    are in hospital. You’re never sure if he/she is kept in the loop about your case.
    Some hospitalists go beyond their authority and change all of a patient’s
    meds and level of care and even decide when you are ready to be released –
    all the while not sharing vital information with the charge nurse who usually knows
    more about the patients in her care than do the hospitalists.
    The final insult to the patient is that they drop by your room nearly every morning,
    stand in the doorway usually and inquire about your progress, any complaints, etc.
    Some will approach your bed — never bothering to check your vitals — and leave —
    after dropping their professional business card on your side table.
    Then — after you are home after a few weeks or so – guess what? You receive a bill from
    your insurance company stating that you still owe a balance — for the hospitalists’
    ‘services.”

    And the hospital administration calls this ‘progress’?

    Liked by 1 person

  2. This is wonderful, seeing the patient as a whole person! Yesterday a student that I know went to see a psychiatrist after waiting months for an appointment. Not only did she wait 2 hours to see him, but for the first half hour of an hour appointment, the doctor had another patient’s file and was confused about who she was. This does not help the patient have much confidence in the doctor’s diagnosis or recommendations.
    Your approach is just the opposite of this and it is so refreshing to see. People are whole persons (bio/psycho/social/spiritual as we were
    taught in Psychology graduate programs) and each part of us affects all of the other parts. Your approach is a truly Biblical approach as well and is wonderful! Bravo!!!
    Carol Molcar
    Ph.D. (Clinical Psychology)

    Liked by 1 person

  3. Is the actual personal intimacy that is needed possible without Time? Without more face to face interaction? Without a reciprocity of trust? Is the Briefness of our time with the DR not the thing to be addressed?
    This has really got me thinking.
    We need more like you, who are brave to keep asking these questions and to keep working toward a better way.

    Like

  4. Heidi,
    more time doesn’t seem to be an option in most primary care practices – we are pretty much in an every 15 minute appointment rut because of the volume of need compared with the diminishing resource of health care providers. It may be we’ll all see a lesser trained provider for longer appointments but that also begs the question of how to have the crucial personal information given to the doctor who often is making the decisions and needs to know about the person behind the numbers and symptoms. I hope we can find a way, as a patient, to be a person, not just a name or number.

    Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.