Enter doctor speaking in italics, with medics and nurses speaking in plain text.
Tell me about the next patient.
Pardon me? Gastric?
Yes, like gastritis pain. It started in his epigastric and then went down to his umbilicus.
Ok tell me more.
He has had gastric for three days. He went to the hospital and they gave him these pills (plastic sachets containing unnamed tablets) but they didn’t work so he came here.
And why did he need to be admitted?
For observation of his high blood pressure.
And how high was it?
Ok, that’s not so high. Why did you think he needed to be admitted for observation?
Because of the gastric.
What is gastric exactly? Is it related to high blood pressure?
Let’s start again. What are his symptoms?
No, what is he complaining of?
Is this related to gastric?
Why did he come to our clinic, and please don’t say gastric?
Ok, now we’re getting somewhere. When someone has pain, we ask other questions to find out more about the pain. It helps us work out what is causing the pain. What questions do we ask?
I don’t know.
Well, what kind of pain is it?
Who on this ward round has ever had any pain?
Right, have you ever had toothache?
What was it like?
Like toothache, doctor.
So it was an ache, rather than a pain. Any other pains? No? How about monthly period pains?
Can you describe them?
Not really, sometimes they are bad, sometimes they are not so bad.
Can you say any more about the period pains?
No, I’m embarrassed.
Ok, what if I were to stab you with a knife. What kind of pain would you feel?
And how is that different from period pain?
It’s from a knife.
But does it feel different?
I don’t know, I’ve not been stabbed before.
But would it feel a sharp pain or a dull ache?
Right, that is what we call the character of the pain. What other types of pain can you think of?
How about “burning pain”?
The pain you get from a burn, doctor?
No, it just feels as though it is burning. Perhaps we should try something different. Pain can be present all the time or it can come and go in waves. Constant or colicky. Do you understand what I mean?
What was his abdominal pain like?
He doesn’t have the abdominal pain now, doctor.
But when he did, what was it like?
Does gastric come and go, or was it there all the time?
I don’t know doctor.
Ok, let’s move on. Pain can move from one place to another. So if his abdominal pain moved or “radiated” to the back, it might suggest an ulcer on the back wall of the stomach or duodenum. If the pain radiated from under the right ribs to his right shoulder blade, it suggests gall bladder pain. Did his pain move anywhere?
To his head, doctor.
But that’s probably something else.
What can affect stomach pain?
I don’t know what you mean.
Well, what happens when he eats food? Does it make the pain better or worse? Does spicy food make the pain worse? Or alcohol?
I don’t know doctor.
Did he have breakfast this morning?
And now he doesn’t have any abdominal pain?
No, but he didn’t eat very much.
Did he feel nausea or did he vomit?
No, but he felt full quickly.
And so it went on. It was clear I wasn’t making a great deal of progress.
So later on this morning, I put together a short teaching session on taking a history from someone who is complaining of pain. Keeping it simple, linking the questions to possible causes of pain. And it all went swimmingly.
So did you learn about this when you did your medic training?
Yes, but I forget.
Does this remind anyone of the monologues of US comedian, Bob Newhart?