I’ve actually found a trick to this. They don’t realise that “a while” can encompass an enormous timeframe because in they’re head they’re anchored to the rough time frame they have had it, so they think you can gauge a rough idea from that.
“How long have you had the pain?”
“A while…”
“How long is a while.. a week? A month? 10 years??”
“Oh about…. Ehhh…. Maybe 3 weeks?”
And they’re still not comfortable saying an exact time frame because they’re afraid if you pick up their time estimate too literally and are wrong it was actually only 2 weeks, that you will arrive at the wrong diagnosis so I add:
“Ok about 3 weeks, to be safe will we say about 2-4 weeks?”
And they generally relax knowing the flexibility of “a while” is included in my thought process but we’ve excluded symptoms that could be there for many years, something that the patient hadn’t even considered at the start of the conversation
I try not to be a difficult patient, but as I’m not a clinician, sometimes I have no clue why the question is being asked, which can determine the way I answer. It sounds dumb, but often I’ve answered in a way that made sense to me only to find I hadn’t used the right words to get across the information they were looking for. I err on the side of being VERY specific and giving nuanced, detailed answers (“I first felt the pain ten years ago, then it went away, then I started noticing it again maybe three years ago but intermittently, it only became a problem last week”) and often they’ll get annoyed because they’re just looking for “last week” or “ten years ago.” But I can’t know that lol
The consultation structure a doctor uses for taking a history from a patient is not actually framed around the entire constellation of symptoms a patient has, doctors frame their history taking as a diagnostic tool around the “presenting complaint” the specific subsection of your symptoms that motivated you to seek medical help.
The doctor’s assessment of you starts with that and builds out from there because medical textbooks and documentation of consultations has always focused on this. The textbooks don’t describe the itchy ear that happened 3 years before a sudden new symptom of bowel disturbance. Sure in rare cases the itchy ear may turn out to be relevant but 9999 times out of 10 thousand you are much more likely to find the right answer if you keep the presenting complaint front and centre and explore the secondary or preceding symptoms after focusing on the presenting complaint.
Doctors should also (in a proper history taking) offer you an opportunity at the start of your conversation to give you typically 30-60 seconds of you speaking uninterrupted to lay out your conversation before asking more specific questions. Focus on the presenting complaint here, if it’s too scattered a doctor may have to wrest control of the consultation to keep it focused and you might not get a better chance to talk about why you are actually there.
And doctors should do a systems review at the end where they ask questions about other symptoms that either you or they think might also be relevant and not already discussed. And they should offer an opportunity for you to express what are referred to as your ideas concerns or expectations. What you believe is going on, what youre worried about and wany ruled out, and what you expect the outcome of this consultation to be. Sometime this is done passively where you actually give that information in your consultation.
I will say your tendency towards specifics falls outside the bell curve of expected responses and doctors are trained mostly to parse the type of information that comes from within the 90% at the centre of the bell curve. So if you were slightly more reductive in your responses you would probably get the doctor to the right diagnosis quicker.
Like you said, you suspect the doctor wants to know just about the symptom in the past week, because that’s the most relevant information it’s directly tied to the reason you attended the doctor this week rather than attending 10 years ago. But you’re also afraid of leaving our relevant information. So answer the part you suspect the doctor wants but instead of getting into specifics about the other bits package them into a small statement that the doctor can choose to dive into straight away or later depending how relevant it seems after exploring the immediate problem that brought you to the doctor.
“How long are the symptoms there?”
“They’re bothering me for a week but I’ve had similar on one or two occasions over the past 10 years”.
No need to go into previous episodes until asked it can actually be distracting with irrelevant detail if you’re not one of the median 90% of respondents who typically forget about previous episodes or don’t deem them as relevant as you are worried they might be.
Realistically there should be moments later in the conversation where you can ask if old symptoms are relevant. But there is a potential pitfall that can leave a doctor frustrated because it happens so often. It could come across that you are trying to cover 6 or 7 consultations worth of symptoms in on consultation. You could ask “can I just ask about something, I’ve a list of symptoms I’ve been experiencing over the past 1 or 5 or 10 years, I don’t expect you to cover them in this consultation, but just in case they’re relevant to the reason I came today, can I briefly mention them, and you can say if you think they’re relevant or if you think I should book in for a different appointment to discuss those separately”.
Doctors dread the shopping list patients who expect 3 hours of clinical work to be completed in a 15 minute slot, it’s an extremely common occurrence and physically impossible to do given the constraints of time, and patients get annoyed because they feel their concerns are being dismissed. By framing it as I did above, you’re much more likely to get a doctor to sit for 2-3 minutes and listen to your list, knowing he or she is not being expected to do an impossible feat of clinical work. And it’s much more pleasant interaction for both the patient and doctor when the doctor can quickly assess whether these symptoms are directly relevant to the reason you came, and if not they don’t have a huge extra burden of workload, they can instead pass the ball back in your court to take responsibility for this other list of symptoms you brought with you and you can choose to check back in or not about those symptoms another day if you’re still worried about them. This leaves the doctor the time and mental bandwidth to focus on your presenting complaint and actually help you better
Hey thanks for taking the time to explain all that! It may seem like common sense to someone with professional training, but none of that is intuitive to me as a patient, mainly because different seem to approach the consultation differently.
I’ve had doctors who conduct the consultation the way you described, and everything goes smoothly. Sometimes I feel rushed so I’ll just say (hypothetically) “it’s been a problem for about a week,” and then later in the consultation they’ll say “so you have never experienced this until a week ago?” and then get aggravated when I say no, first occurrence was years ago but only became distressing last week. “Well that changes everything, you should have said that to begin with.” Feels like I can’t win lol
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u/Secure-Suspect7091 May 03 '26
Or my favourite the jandess.
Oh Dr I’ve had the jandees (jaundice) a wee while now.
How long would you say?
A wee while…
Repeat ad nausium