Our history, your future - Chris Bidder

As RCPCH celebrates its 25th birthday, 25 members have shared stories about a case that stayed with them. These stories will be published throughout the summer.
Picture of Chris Bidder
Dr Chris Bidder

I was by then a senior paediatric registrar, two years from becoming a consultant and equipped with good levels of skill and knowledge. Even so, I still experienced anxiety as I arrived for a night shift on the “specialities” side in the tertiary hospital: the fear of the unknown at what might be waiting for me at handover causing a familiar sense of unease to manifest itself in my physiology.

On this occasion, however, handover was swift and smooth and a speedy saunter round the wards confirmed the patients did indeed have plans and were stable. Even the oncology wards did not require an extended period of fluids and electrolyte prescriptions and no one was “poorly bad”. With the bonus of an experienced and friendly Senior House Officer to share the shift, I thanked the on-call gods and congratulated myself on my choice of snacks and the book that I had remembered to bring, and settled into the most comfortable position one can in a plastic chair.

The bleep went off. I liked the neurology consultant. She was clever, experienced and kind. I am sure we would have been pals at medical school had we been there at the same time. 10:30pm was a standard time for an “off to bed” check in from some consultants, but this was not the standard call: “Chris, I know it’s not busy so I’ve got a job for you.” I will be honest and say my heart did not leap with enthusiasm.

Dr F then described in detail the history she had taken from a new patient* transferred from a district general hospital after a respiratory arrest. He had seen multiple staff members locally and in the tertiary centre before her, but she had invested a substantial amount of time in going through the history in detail and eliciting some symptoms that had not been picked up previously. She told me he must have a syndromic diagnosis and I would have time to use the books/internet to figure it out by morning when she would expect an answer.

Happily for me, five minutes later Dr Google had made the diagnosis. The right phrases entered into the search engine linked to a paper from London with a case series of a dozen or so children with a relatively recently described syndrome. This patient met the diagnostic criteria and I printed the paper out for his notes and returned to my book feeling fairly smug.

I know that it is essential to allow parents and young people the time and space to tell their story and for me to listen actively and intently, without interrupting

From day one in medical school, we are taught the importance of history taking. “Just listen to your patient, he is telling you the diagnosis”, said William Osler. Dr F had invested the time and energy that was necessary to make the diagnosis for this young boy and the internet had linked together the symptoms she elicited. I know from experience that it is essential to allow parents and young people the time and space to tell their story and for me to listen actively and intently, without interrupting. Yet the average time it takes a doctor to interrupt at the start of a consultation around the world is between 12 and 28 seconds; I know my behaviour is often within this statistical range.

How can a GP be expected to take a history in this ideal fashion during 40 plus 10-minute appointments each day? How can I do it during a 12-patient paediatric clinic? Can we support patients and parents to realise the importance of their story? Can we say in the appointment letter that the story of their illness is far more useful than any investigations I could arrange and how helpful it is to reflect on their illness and prepare what they want to say before their appointment? I know I do this for my health appointments. Why do doctors sometimes forget just how important the patient story is?

The question I am left with is: does the time and space exist in modern healthcare systems to allow a proper history to be taken?  And if not, how do we design it back in?

Dr Christopher Bidder is a consultant paediatrician in Swansea Bay UHB with a special interest in diabetes and endocrinology.  He enjoys trail running, paddleboarding and beach fire cooking on Gower.

  • *. Any information that could identify someone has been changed