Yet several writers have used the experience of illness as a telescope rather than a microscope—often by telling the truth but telling it slant, as Emily Dickinson advised. It pains me, as a doctor, to admit that the “straight” story, the one that must be slanted to become art, is often the one imposed upon the patient by the medical profession. In the hospital or doctor’s office, to tell your own story in your own, slanted way is to risk being a bad patient, a “poor historian.”
I first heard this term many years ago as a second-year medical student. In a course called Clinical Skills, we practiced interviewing and examining hospitalized patients, and then writing about them. Our instructors required us to include at the top of our reports an assessment of whether the patient had been an excellent, good, fair, or poor historian. “A fifty-eight-year-old man was admitted with fever and cough. The history is obtained from the patient, who is a good historian.” We reserved a “poor” grade for those whose ability to communicate had been impaired by dementia, stroke, or mental illness. But sometimes “poor” simply meant that the patient rambled on, relating events out of chronological order, insisting on his or her own wrongheaded opinions regarding cause and effect. “And ever since they took my appendix out I’ve had this problem with my ears,” for example.
A few weeks after I completed Clinical Skills, in the summer of 1984, medical ethicist and poet Dr. John L. Coulehan published an editorial in the Journal of the American Medical Association suggesting that doctors jettison “poor historian,” which he found patronizing and inaccurate, a sneaky semantic attempt to blame patients for doctors’ shortcomings. After all, Coulehan pointed out, it’s the doctor, not the patient, who’s the historian, the one who gathers the data and crafts the written record. If the history is poor, it’s the doctor’s fault. And besides, who’s to say that only one way of describing the experience of illness is “excellent”?
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