When patients are labeled as “poor historians,” it implies that they’re not to be trusted.
I admitted an 85-year-old patient with dementia who developed rhabdomyolisis after being stuck on the ground for a very long time. Below is a poem based on what he told me. I was rushing as I took his history and labeled him a “poor historian.” This makes me wonder how many “poor historians” are labeled by clinicians who feel rushed.
You ask me if I fell and for how long I was on the ground.
It’s just a curiosity for you
but it was a choice for me.
Is this when I die
or should I try to stay alive?
I counted seconds, hours, and days
for my helper to come.
At 3 am
I looked up at the ceiling
and saw a white rectangle.
I wasn’t sure if this was part of the ceiling of my trailer
or a part of my dying.
At 8 am
my helper finally came
and found me frozen.
She called the ambulance.
Then somebody who looked like you unfroze me
and saved my life.
When I finally opened my eyes
I saw the white rectangle again.
So I said to it
I beat ya!
I didn’t die.
There’s almost always a sad story behind rhabdomyolysis: an old person who was down and alone for a long time, scared, and hopeless. As people’s muscles slowly break down, and their kidneys failing, their mind sometimes goes too. But before that happens, they suffer quietly, frozen in time.
When the patient finally arrives at the hospital, they have a story to tell. But often they can only do it deliriously, and are then labeled a “poor historian” in the medical record. This label doesn’t just mean the patient isn’t giving a good history of their present illness, it also indicates that the patient isn’t to be trusted, or worse yet, that their experiences aren’t real. We owe it to our patients to slow down and listen, through the delirium, dehydration, and failing organs. We must always listen to their story.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.