House on history taking

By Hannah Brown in A doctor's life on Tuesday, August 4, 2009 @ 09:25

After two weeks in the South of France and one day back at work I'm struggling to remember the feel of the sun on my skin, sand between my toes and the taste of a crisp white wine.  I spent two weeks sunbathing, water-skiing, relaxing and watching a lot of "House".

I missed out on House the first time round, and the second, and I think it might be in its fifth season now.  I worked my way through season one on my iPhone on the beach, at the airport, sitting in cafes, and was thoroughly antisocial.  I'm addicted to Dr Gregory House's acerbic arrogance, and his stunning 'anti' communication skills. 

I worked my way through series one on my iPhone on the beach, at the airport, at cafes, and was thoroughly antisocial.  However, it hit me fairly early on that despite Dr House detesting patient contact (because all patients lie), we have a lot to learn from his largely criticised communication skills.

Using the ethos that patients can't be trusted, House's history taking relies more on what is implied, inferred and subtle, rather than the obvious.  Deciding when to dig deeper and how to elicit what the patient deems irrelevant, embarassing or even something they are desperate to hide is a skill that we need to hone, and this is where we can learn from Dr House.   Exercise caution though, sometimes patients are telling you everything you need to know.  Look for subtle signs of lying; looking to the left, not making eye contact - does their 'story' add up?

My friend's yearbook quote was "being blunt is easy, it's the digging deeper that takes skill" - she's now a medic, taking MRCP PACES, and apparently very good at history taking...