EDP column by Professor Ketan Dhatariya

“I was to hospital recently via the accident and emergency department and saw about 6 or 7 doctors in the first few hours all asking me the same questions, and all said they were ‘part of the team looking after me’. If they were all part of the same team, why did I have to repeat myself so often?”

Good question. It seems that when people are first admitted, so many things change that it is often a whirl of activity. New faces, changes in environment and often a loss of independence. To try and find out what is wrong and to help make the correct diagnosis, it is important that we take a history. This is the story of how you came to end up in hospital – when your problem started, how it has affected you, have you had it before, and so on.

Very frequently it is a junior doctor who will see you first. As both the Norfolk and Norwich and the James Paget hospitals are part of the medical school of the University of East Anglia, it may be that you are seen by a medical student first. They will ask you the questions that they think are important. Often they will then go and report their findings to their ‘line manager’, the next most senior person in the team – what is currently known as a House officer or a Senior House officer (these names will change soon, but I will deal with the changes in a later column). These, more senior doctors may ask a much more detailed history and try and tease out the most relevant parts relating to your reasons for admission. There is often an element of repetition and overlap between what you are asked and what you said before.

These doctors may then report to their seniors (currently called specialist registrars) who may repeat the history again, if they are not sure what is going on, or if there are few things they want to clarify. Finally you will probably meet the consultant who is ultimately responsible for your overall care. It is the consultant who supervises their junior staff (any doctor who is not a consultant is called a ‘junior’).

Having people ask you so many questions again and again can be very frustrating and it may seem like all of the people involved are not talking to each other, but in fact, there is a balance that needs to be reached. Firstly the correct diagnosis needs to be made and the way to do that is by taking an accurate history of what made you come into hospital. Secondly it is a matter of training. Medical students and junior doctors learn on the job – it is much easier to learn about a condition when they have seen it in ‘real life’ then out of a textbook. Don’t think of yourself as a guinea pig, but allowing the senior doctors of tomorrow to increase their knowledge and skills today.