Thursday, January 06, 2005

Okay, So I'm Not Sherlock Holmes!

During their education medical students learn the proper way to interview patients, in order to obtain crucial information that pertains to the problem at hand. As those of you in the health care field know, this process is called obtaining the History, which has seven standard parts. They are to be documented in the chart, usually in the following order:

Present illness (a narrative of symptoms)
Past Medical History
Family History
Social History
Review of Systems

We were all taught in school to do a thorough job taking a history, for often embedded within this morass of information are clues that will lead us toward the correct diagnosis. Unfortunately many doctors develop a rather cavalier attitude about the history as they ripen in their careers. Taking a history is tedious, and if the interviewee should look upon this occasion as a invitation to dictate their life story, the doctor will soon decide that the fewer the questions asked, the faster he can get out of the room and on to the next crisis. Shortcuts are found, such as copying the answers recorded by the admitting nurse. Eventually whole sections of the history are skipped in the name of conservation of energy. Such time-saving maneuvers seem to be a neat trick but I believe that one is always better off to put the deerstalker cap on, pull up a chair and listen to the patient's story - for sometimes one small detail can solve the Mystery of the Dyspneic Man.

I was reminded of the importance of taking a complete history by the following case, in which a patient was diagnosed with a malignant mesothelioma without any apparent exposure to asbestos. As you know, asbestos exposure is essential for the development of the cancer. Just for fun, let me present a few details to you and then see if you can figure out what I forgot to ask. I might add that once the key piece of information was revealed I felt like an idiot for not thinking of it, as it immediately answered the question as to where he was exposed to the deadly mineral.

Here are the clues:

The patient is a 60 year old man with a pleural-based mass, a large mediastinal mass and a pleural effusion. Biopsy of the pleural mass revealed mesothelioma.

He has a history of smoking. He works as an manager for a construction firm but does not visit construction sites until they are finished - denying any exposure to asbestos through his job.

He denies helping with any demolition of a friend's house, or working in the railroad as a teenager, or living in a home where asbestos was present or brought home on work clothes. He simply cannot think of any time in his life when he was around such materials that could contain asbestos, and I was stumped at the end of our interview.

One week later, he volunteered a new piece of evidence about his past.

Upon hearing this new tidbit I slapped my head and cried "Come Watson, come, the game is afoot!," lit my pipe and stepped out of 221b Baker St. into the dense fog.

If you would like to guess what part of Mr. Dyspneic's past I forgot to query, feel free to comment below. I'll be happy to pay homage to the first correct answer!

1/7/05 Addendum: answer is posted in comment section.


At 10:06 PM, Blogger Caltechgirl said...

His office? I thought of this because half the dental school at UNC is taped off right now....

At 10:31 PM, Blogger Allen said...

Well, the best flea question for fascinomas is "what pets do you have", but I cannot think of any asbestos-containing pet.

I would ask him about his hobbies, specifically, does he do his own brake work? There's a decent source of exposure.


At 11:36 PM, Blogger Dr. Craig Hildreth said...

To the above sleuths:

No, the office was not contaminated.

No, he didn't win an asbestos-laced dog at the county fair.

Grunt Doc: thanks for linking to me. If working on brakes can cause mesothelioma I've got nothing to worry about! He doesn't, however, work on cars.

At 12:09 AM, Blogger mrlmd said...

When did he serve in the Navy? (most likely in a shipyard, classic asbestos exposure)

At 9:25 AM, Blogger Texas Libertarian said...

To where has he traveled within the past 5-10 years? Has he been to Manhattan or Oklahoma City?

At 5:36 PM, Blogger Dr. Craig Hildreth said...

mrlmd was right - the patient served on a Navy ship from 1960-1962, working in the engine room. This case is a reminder for doctors to ask about prior military service when completing the social history.

At 2:52 PM, Blogger CommaKazi said...

Was the patient a Kent smoker?

There was a class action suit started in the United States about 8 years ago because many Kent smokers were dying of lung cancer caused by the "safer"
patented Micronite Filter. The special fibers were full of asbestos.

At 10:20 PM, Blogger coturnix said...

At 12:21 PM, Anonymous Anonymous said...

anal asian fisting*
free asian pics*
blonde indian swinger*
asia class first*
asian blonde clit*
asian free mr*
asian black pic*
indian sex swinger*
asian girlss young*
cunts indian toe*

At 9:25 AM, Blogger NewsMan said...

vagina toy*
free penetration vids*
double penetration pussy*
pissing movie gallery*
anal fisting technique*
lesbian review*
movie lion lesbian*
rooms lesbian black*
extreme anal lesbian*
lesbian lingerie gallery*

At 7:53 PM, Anonymous Heidi said...

Amazing blog! I really enjoyed reading and hope you keep updating it frequently! I really liked the information on asbestos! I have my own asbestos blog if you would like to come and see what I have on mine! Also, may I put a link to this blog of yours on mine?

At 11:10 AM, Blogger jasmine said...

I love your information on asbestos! I bookmarked your blog and will be back soon. If you want, check out my blog on asbestos secrets that shows unveils all the secrets there are to know about asbestos. May I put a link to this blog of yours on mine?

At 6:16 PM, Blogger mesothelioma said...

Nice site! :)

If you get a chance, why not check out my lung cancer

At 9:48 PM, Blogger Steve Austin said...

Enjoyable blog. Please check out my mesothelioma research. It is all about mesothelioma research.

At 7:08 AM, Blogger mesothelioma-attorney-ycg said...

Looking for information on lung cancer picture
Check out this site - lung cancer picture

At 9:53 PM, Blogger hazeydaze77 said...

Hey, blogger. I was just blogging around and sharing some info about a site I have with others. My site is about mesothelioma research. If you or someone you know have mesothelioma cancer, than you should check out our site for important information on mesothelioma research.

At 4:13 PM, Blogger Bloggy said...

It's always good to find more resources about board discussion mesothelioma, and I too have a couple of pages about Mesthelioma,
board discussion mesothelioma
board discussion mesothelioma

At 4:47 PM, Blogger Mesotheliomata Attorney said...

I was just browsing through a few blogs, looking for information related to my mesothelioma attorney site. That's how I came accross your blog. I know our sites are not exactly related, but I figured I'd leave a comment to express my appreciation for the great content you got on your blog, and I'd like to extent my personal invitation for you to visit my site if you are even the least bit curious about mesothelioma attorney, or anything related to mesothelioma.

Let's end the pain and suffering of this deadly disease

At 1:35 PM, Blogger Mesothelioma Cancer said...

I'm going to bookmark your blog straight away! It's amazing

I have a mesothelioma lung cancer site/blog. It pretty much covers ##KEYWORD## related stuff.

If you get time check it out.

At 4:19 AM, Blogger Tom Naka said...

Hi i am totally blown away with the blogs people have created its so much fun to read alot of good info and you have also one of the best blogs !! Have some time check my link of mental health support group

At 7:07 AM, Blogger Mesothelioma Cancer said...

Amazing blog! Very useful info.

I have a mesothelioma litigation site/blog. It pretty much covers mesothelioma litigation related stuff.

Check it out if you get time :-)

At 8:32 AM, Blogger Jim Naka said...

Your blog is excellent - keep it up! Don't miss visiting this site about cheap kid toy

At 1:59 AM, Blogger dot wop said...

What is mesothelioma?

Mesothelioma is a rare disease caused as a result of malignant cancerous cells lining the patient's body cavities such as chest, abdominal region or the area surrounding the heart.Your legal rights:

Corporations that manufacture asbestos products have known about the dangers of asbestos-related diseases for more than six decades. In an effort to increase profit, they kept this information quiet, putting workers and families at risk.

Working with asbestos causes serious diseases. Unfortunately, many corporations thought they would be able to cut corners and make a large profit at the expense of endangering workers. Fortunately, there are laws that help to protect those individuals that have been harmed by exposure to asbestos-related products.

Spread the information and help as many as possible.
**Mesothelioma Informations**

At 10:42 AM, Blogger Gordon said...

Hi, I was just blog surfing and found you! If you are interested, go see my Mesothelioma related site. It isnt anything special but you may still find something of interest.

At 10:20 PM, Blogger Free Traffic System said...


I liked your blog. I found many interesting information here.
I also give free info about exchange forex link signal on my
href="">Forex Trading System

If you have time please visit my web site to get some free exchange forex link signal

Kind regards,

At 12:05 AM, Blogger amacdrummer said...

If you need cancer cervical symptom info... Go to this cancer cervical symptom site : cancer cervical symptom

At 7:13 AM, Anonymous Anonymous said...

heh cool blog you have here!

I noticed you have a nice blog, read all of your links kept me interested for a good time! well done :)

Thanks for a good read instead of some of the other stuff people post here!

At 8:34 PM, Anonymous Anonymous said...

Wow. Really Good Post. mesothelioma lawyer

At 12:57 AM, Blogger Gordon said...

Hello, your blog is informative . I have a website related tocurrency chart, so you can compare the currency rates of different time frames easily. Charts of major currency pairs can be found there, the site should be helpful to your forex trading.

At 9:05 PM, Anonymous Anonymous said...

Hey, you have a great blog here! I'm definitely going to bookmark you!

I have a lung cancer picture site. It pretty much covers lung cancer picture related stuff.

Come and check it out if you get time :-)


At 9:30 PM, Anonymous Anonymous said...

Hey, you have a great blog here! I'm definitely going to bookmark you!

I have a minnesota mesothelioma lawyer site/blog. It pretty much covers minnesota mesothelioma lawyer related stuff.

Come and check it out if you get time :-)

At 8:55 PM, Blogger circlejerker said...

Was just out blog browsing and came upon your site.

Noticed you have some pretty similar content, so thought I would share my site with you. My site is about asian anal sex and you will not find a better site on the net about it. So check it out.

At 2:33 AM, Anonymous Anonymous said...

If you are into "swinger bars" like my wife and I are. You will find lots of info on "swinger bars" at "swinger bars".
Check us and it out, lol.

At 11:32 AM, Blogger Diamond Dealer said...

Did you know that mesothelioma cancer is work related 90% of the time, and that you are entitled to a claim against the companies.

Have you lost someone close because of mesothelioma cancer?

Visit us to help find a mesothelioma attorney near you today!

At 8:44 PM, Blogger . said...

I just came across your blog, and wanted to drop you a note telling you how impressed I was with the information you have posted here. I also have a forex trading blog, so I know what I'm talking about when I say your site is top-notch! Keep up the great work, you are providing a great resource on the Internet here!

At 4:01 PM, Blogger . said...

I just came across your blog, and wanted to drop you a note telling you how impressed I was with the information you have posted here. I also have a forex training blog, so I know what I'm talking about when I say your site is top-notch! Keep up the great work, you are providing a great resource on the Internet here!

At 1:08 PM, Anonymous Anonymous said...

Consider the power of being able to create incoming links to your site any time you want them...

At 7:09 PM, Anonymous Anonymous said...


Just browsing around the net for forex charting software and came across your blog. I've been trying to add as much info as I can about forex charting software on my site. But must admit I get a bit confused... there's just some many sites, tips, information ... you name about forex charting software it's hard to know where to begin!
I'm thinking of adding a forex charting software on my site, when I do, your all more that welcome to come a leave tips and help...

Until then take care!

At 12:41 AM, Blogger Johnny said...

Every online business need free traffic. This free traffic handbook is very update and helpful.

At 7:58 AM, Blogger Editor said...

Hey, you have a great blog here! I'm definitely going to bookmark you!

I have a testicular cancer symptom site. It pretty much covers Cancer related stuff.

Come and check it out if you get time :-)


Post a Comment

<< Home