“The diagnostic team that treated Duncan — who had symptoms of headache, abdominal pain and fever consistent with the Ebola virus — did not know he told a receiving nurse that he had traveled from Africa. On that day, Duncan was sent home with antibiotics. He returned to the hospital by ambulance two days later.”
http://www.latimes.com/nation/nationnow/la-na-ebola-hospital-20141003-story.html
As the Ebola virus continues to make world news, I am struck that one important aspect of this story is not getting enough press. The nurse got the history of possible Ebola exposure, but the doctor did not. Nor did the nurse adequately communicate this VITAL piece of information to the doctor. This viral scare, from my point of view, highlights the prime importance, once enforced in medical training, and now less so, that a doctor MUST always take his/her own history. The idea of relying on other professionals for a history of present illness, as in this tragic case of Thomas Duncan, can cause fatal mistakes, History taking is/was the foundation of good medical care. This was the most important thing I learned in medical school, in rotation after rotation. Yet, today, there is a notion that professionals should work to the highest aspect of their license, meaning that one does not need an MD to take a history. Physicians are needed to prescribe, to order tests, but not to get background information. This background can be obtained by medical assistants and nurse practitioners.
Oh, no no, I say, learning of this paradigm change in health care delivery. With all due respect to nurses, there is the art to history taking with leads to accurate diagnosis and treatment. My professors, rightly, and repeatedly, taught me this. 80% of the diagnostic information is from the history, they would say, which became the often mocked mantra. Yet, almost thirty years later, those words come painfully alive, as we discover that the doctor did not do a “travel history” on Mr. Duncan. This pertinent omission of the history has sent this country into anxiety, reaching near panic levels in some. The focus has been on politics, on travel bans, on protective gear training, and yet, where are the doctors yelling about the need to reinstitute history taking as the vital art in medicine? Yes,in most cases, the history is less critical and symptoms can point the physician in the right direction. However, once in a while, a critical case will come in the Emergency Room, and like Chelsey Sullenberger, the pilot who landed the plane in the Hudson, with rarely used, but critical skills, doctors need to have history training for that, perhaps one time in their career, where it really matters.
Shirah Vollmer MD 