Have you ever wondered why you move from one doctor to another without getting better?

Have you ever wondered why you have swallowed drugs from one hospital to another without your health problems not going down and instead becoming worse?

To answer the above questions, it all boils to the story of how you developed the symptoms of your medical problem.

In medical terms it is called “the (hi) story of the presenting symptom/complaint”

1.  In about 70 % of cases, your medical disease/condition/diagnosis is got from the story you tell your doctor on how it all started.
2. In about 20% of the cases, your medical condition/diagnosis will be got by a proper physical examination of your body from head to toe.
3. In about 10% of the cases, your diagnosis will be got from the laboratory investigations, imaging (Ultra sound scanning & X-rays).

The proper story of your  presenting complaints has two parts:

Part 1:

What you tell your doctor on how the problem started and how it has progressed while your doctor is listening attentively.  

Part 2…

Is for your doctor to ask after listening to the whole story of your complaint and make further   clarifications in your story of how the disease began:

Example: if your complaint is abdominal pain

1. Your doctor will want to know when the abdominal pain started…how long ago,  exactly where  it is located: upper  or lower abdomen( this tells the doctor which parts in the abdomen are mostly affected)
2. Your doctor will ask you to describe that pain-its nature: is it sharp, dull, stabbing, continuous or cyclic/colicky etc.  All this description of the nature of the abdominal pain points to which part is affected and the probable causes because each part on the abdomen has corresponding organs below it known better by the doctor.
3. Your doctor will ask you what reduces or makes the pain worse eg eating food, coughing, vomiting, passing stool , lying on your abdomen, squatting, breathing, walking,  taking some medicines and which ones etc  
4. Your doctor will want to know how other systems of the body have been affected by this pain( review of systems): like having  fever,  headache, loss of appetite,  vomiting ,abdominal fullness, palpitations( heart pumping faster than usual) loose stools or constipation, lack of sleep, difficulty in  urinating,  or vaginal bleeding in ladies etc
5. Your doctor will ask you how old you’re. Some abdominal pains point to some diseases that are common in certain age bracket eg dull abdominal pains in children is usually intestinal worms and abdominal pains in old people or elderly may point to cancers.
6. Your doctor may ask you about your tribe. In Uganda westerners have more abdominal cancers and throat cancers than other regions. Research going on is pointing more on taking alcohol and smoking as a probable cause of such statistics.
7. Your doctor may ask you about your religion. This is important in management like in Islam embarrassing questions of how much alcohol you drink are not asked when the doctor is thinking about stomach cancer.  In the Jehovah believers they don’t accept blood transfusions.  So in the event of surgery on them, the doctor already knows what to do.
8. Your doctor may ask the type of work you do for a living or your occupation. This may help you in the management, like which drugs to give you. Some drugs may cause dizziness or feeling sleepy. If you’re a driver, then will give you other drugs that don’t cause such side effects.  
9. Your doctor may want to know if you have ever been admitted or operated on the abdomen in the past. Post- operative complications my arise and be the cause of such pains

• Your doctor may ask about your educational background. This can help to know if you’re likely to have poor hygiene diseases like Typhoid fevers, intestinal worms, food poisoning all of these cause abdominal pains.  Low education background is linked with ignorance of knowledge on disease prevention.  “Prevention is better than cure”. 
• Your doctor may ask about your lifestyle: drinking alcohol, smoking etc…It is common medical knowledge that alcohol and smoking are responsible for most of abdominal ailments.
• Your doctor may ask you about family history of diseases like stomach cancers, hernias, etc because some diseases run in families.
• Your doctor may want to know if this is your first experience of this type of pain or has been recurring in the past.
• Your doctor will ask if you have used any medicines/herbs and how they have affected the pain. 
• The doctor may ask you if you have allergies or reactions to known drugs you have used in the past. Such question dictates to the doctor what medicines to avoid and not to give to you because drug reactions have killed patients and continue killing them if not taken care of or asked in advance.
•  Lastly your doctor may ask if you have any clue what could have caused that abdominal pain. 

When you give the whole story of your complaint/ problem and answer well your doctor’s questions concerning your problem, the doctor will be about 70% sure of where and what are the likely causes/diseases of your complaint/problem and has next do a thorough physical examination on you from head to toe in relation to what he/she thinks is the most likely causes of your abdominal pain.

This may necessitate telling you to remove your clothes and sees for himself/herself where to concentrate and examine you in privacy and in very good light.

This physical examination will further reduce the list of possible diseases the doctor had thought about as you gave your story of the abdominal pain and leave very few probable diagnoses (differentials) that are affecting you. At this stage the doctor is about 90% certain of the few diseases left in his/her thoughts that are most probable cause of you pain.

Finally the doctor will order relevant and very important investigations tailored to your story of your complaint and his/her findings based on physical examination of your body to eliminate the few remaining list of the probable diseases by way of doing laboratory tests on blood, urine, stool, and also do imaging examination (ultrasound scanning and X-rays) on your abdomen.

This will further exclude other possible diseases and yield to 100% certainty of the diagnosis or remaining conditions that is/are causing your pain hence you will get the proper treatment and heal from your disease.

What I have observed in my 32 years of medical practice and are lessons to you:

1. Clients/patients always don’t want to tell the whole story instead want to tell short cuts:  they come and tell us that I have peptic ulcers, or malaria or allergy which are baseless and not useful to the client or the doctor consulted. They even go ahead and tell you what drugs/medicines they want to buy or be given as if medical consultations/treatments are handled like in supermarkets!!!
2. Clients/ patients most often and make very expensive investigations of lab tests, X-ray or Ultrasound scans or buy expensive drugs on their own( self-medication) which are not only costly but useless after they tell  their full story of how the complaint started.
3. Medical doctors/health workers are counsellors/advisors on how you can use your money rationally as far as your medical problems are concerned ie spending your hard earned cash wisely medically.
4. Clients/patients want or plead with the doctor to reduce the list of investigations to suit their pocket ( money) in most private health care facilities but ignorantly not knowing that it is to their ultimate health benefit when a proper diagnosis is made and proper management is instituted.
5. There is a lot of health information on social media platforms and internet through Mr GOOGLE, but that does not mean to ignore the doctors/health workers consultations or advice who are experts in the  field of health  because they are trained not to look at only one symptom or two and make a conclusion but they look at a bigger picture of symptoms, physical findings and investigations to make a conclusion.