In the fifteen years I’ve worked in medicine, I’ve met thousands of patients, and I still feel some annoyance when asked about their social history, which deals with personal lifestyle choices, such as tobacco, alcohol, drugs, and sex.
I usually leave it to the end, after building trust and rapport by talking about the problem that brought the patient to the hospital (“current illness history”), other medical problems they have (“previous medical history”), their medications, allergies, weather, and traffic in Their way here and the recent performances of the local sports teams.
Until then, I begin by saying that I ask everyone questions of social history, to make it clear that I am in no way targeting them or making any assumptions. I am concerned that the patient may think that these questions are not medically relevant because they do not involve biology or anatomy. I also fear that they may feel embarrassed or defend their answers. Therefore, I am aware that there is an impartial and non-judgmental space to invite them to tell me the truth.
The question of social history feels like stepping into someone’s protected private lands. Not only do we want to know if you drink, but what kind of alcohol you drink, how many, how often and when you last had one. In medical school, we were taught to say, “Do you have sex with men, women, or both?” He followed it up with questions about the number of sexual partners, the use of protection, and the physical and emotional integrity of relationships.
Why do medical providers embark on the embarrassing challenge of investigating these private details of every patient we see? there are many reasons:
The dangers of stratification. Lifestyle choices affect your likelihood of developing certain diseases. If you have a 20-pack history (you smoke one pack per day for 20 years), you qualify for annual screening for lung cancer. Smoking is a major risk factor for COPD, which can be verified with a simple breath test. In addition, smoking increases the risk of cardiovascular disease. Males aged 65-75 years Ever An abdominal aortic aneurysm, an abnormal bulge in the largest artery in the body that can burst and kill you within minutes, should be examined. Not knowing the patient’s smoking history may miss the chances of early detection of fatal cases.
diagnose. Facts in your social history can help reveal the cause of your illness. A patient comes in with a heart attack, but the imaging shows the coronary arteries clean. They may suffer from cocaine-induced coronary spasms that restrict blood flow to the heart muscles. But this possible diagnosis wouldn’t come to mind if we didn’t know the patient was using cocaine. If you’ve watched the medical drama “House MD,” you know that clues from the patient’s lifestyle, which often require the team to break into the patient’s home to get them, are key to solving the mystery of diagnosis.
treatment interactions. Both long-term habits and short-term use of tobacco, alcohol, and drugs can change the way our bodies react to medications. This is particularly relevant to my work as an anesthesiologist. Patients who drink alcohol regularly or take marijuana products tend to require higher doses of the drug because their brains are used to the sedatives. Amphetamine users can lower their blood pressure to dangerously low levels when they sleep under anesthesia.
anticipation. Based on the patient’s complete history, we can anticipate what might happen and prevent damage. Being in the hospital means no access to tobacco, alcohol, heroin, and other drugs, and many patients go into withdrawal. We can give alternative agents (eg benzodiazepines for alcohol drinkers and morphine for opioid users) to reduce the effect. Smokers tend to produce a lot of secretions and irritation from having a breathing tube inserted under anaesthesia. Extreme care must be taken to maintain their breathing during surgery and to eventually wean the ventilator.
These explanations do not change the intrusive nature of social history questions. But I hope hearing this basic information will make you more receptive to questions and share your answers the next time you see a medical provider.
King Yang and Kevin Parker are a married couple who live in Springfield. Dr. Yang is an anesthesiologist. She received her medical degree from Yale University School of Medicine and completed residency training at Massachusetts General Hospital. Parker has helped formulate and manage public policy in various city, state, and state government entities, including the Illinois Department of Innovation and Technology and the Illinois Emergency Management Agency. This column is not intended to replace professional medical advice, diagnosis or treatment. The opinions are those of the writers and do not represent the opinions of the employers.