Learning how to conduct an efficient, competent medical consultation is one of the first lessons learned when training to become a health professional. There are key questions to be asked and a basic interview structure to follow. But the value of this exchange lies beyond the questions we are taught to ask.
An inquisitive, compassionate bedside manner and strong interview skills takes practice and patience. Clinicians work at this skill their entire career. It is in the fine details of a patient's description of their condition and daily lifestyle practices that often holds the key to the correct diagnosis. When patients feel rushed, important details are commonly missed. According to a study published by medical journal The BMJ, allowing patients to tell their "opening story" in a consultation requires little time and does not disrupt the other components of the clinical encounter. This study found that, when uninterrupted, patients typically complete their opening monologue in less than 30 seconds in a primary care setting. Clinicians are encouraged not to interrupt this exchange.
Initially, the cause of pain or explanation for a recent decline in health is not always clear to a patient or clinician. In sharing daily choices and habits, patients reveal the influence their routine has on the expression of their genes and overall health. These habits affect risk of chronic disease, stress resiliency, rate of aging and possible mechanism of injury or dysfunction. Armed with this information, a skilled clinician can begin to form a differential diagnosis, structure the required examination(s) and form a plan of action.
According to the Canadian Foundation for Healthcare Improvement, more than half (56 per cent) of all Canadians aged 12 or older report living with at least one chronic condition. At the top of this list are diabetes, arthritis, depression, high blood pressure and high cholesterol.
This number is alarmingly high. Yet, the impact our lifestyle practices have on our risk of developing a chronic disease is still a surprise to many. We make thousands of seemingly small decisions each week that hold tremendous power over our health. Recognizing the influence of daily rituals is vital to maintaining good health. Sharing these details with your clinician will affect the quality of the care you receive.
By spending a moment to consider your weekly habits and frequent choices, you can help your clinician guide you down the correct path. Consider making a list of your habits with a focus on activity levels and nutritional practices.
At your next consultation, share your list and request a future appointment time to discuss the impact it may be having on your health goals. Your clinician will thank you for this pro-active approach and your respect for the additional time required to have a meaningful discussion about lifestyle habits.
Here are some questions to consider when looking at your weekly routine:
1. Are you happy?
2. Do you have the energy to live life at your current pace?
3. How many hours do you sleep each night? Do you wake feeling rested?
4. Record your diet diary for a full week, listing all food and beverages consumed. Include food prep habits.
5. Are you happy with your body weight?
6. Do you smoke? Do you drink alcohol? If so, how much?
7. Do you enjoy physical activity?
8. Is your ability to move and/or pain preventing you from living an active lifestyle?
9. Do you have moments in your day without pain?
10. How many times a week do you exercise for at least 30 minutes?
11. Are you too tired to exercise?
12. How long do you sit every day?
13. Do you feel stressed?
14. Do you have time for personal interests/hobbies outside of work?
15. What worries keep you up at night?
The answers to these questions will help shine a light on the impact your routine has on your health and will spark a valuable discussion with your clinician. The practice of prevention starts with a thorough interview.
Dr. Dwight Chapin, B.Sc(H)., D.C., is the clinic director of High Point Wellness Centre in Mississauga, Ont., team chiropractor for the CFL's Toronto Argonauts and on-site clinician for employees of The Globe and Mail. Follow him on Twitter @HighPtWellness.