Maybe it was because of her own personal experiences of taking nebulous histories from pet owners, but she seemed to revisit the chief concern after every system reviewed. For example, after confirming that Lexi didn’t have any changes in stool, she explained that parasitic disease can cause musculoskeletal complaints. So she went back to my description of Lexi’s limp and asked about any preceding gastrointestinal illnesses. Throughout this reinforcement, she kept asking me if the story was being adequately represented—something that I appreciated. At the same time, she was looking carefully at the questionnaire to methodically ascertain if what I was saying matched what I had written earlier. In fact, she even marked a few questions with more details that I relayed in the conversation.
This approach took some extra time, but it made sense. Dr. N wasn’t only gaining information to resolve a clinical dilemma but she was activating me, prompting me to make connections between the symptoms I was relaying with the chief concern. In the process, she was also educating me about what to expect, empathizing with me about Lexi’s problems and prompting me to consider alternative explanations.
I can understand how this may not necessarily be applicable to many (if not most) cases in a busy rheumatology clinic, but in unclear cases where the history isn’t making much sense, I can distinctly see its value.
Close Observation
I’ve always been an aficionado of the physical examination, so I was particularly intrigued by how Dr. N would approach Lexi’s physical examination. Dr. N was pretty perceptive, so I imagine that at this point, she realized she was talking with someone familiar with medicine and healthcare. Certainly, I couldn’t hide the degree of interest I took in seeing her physical examination maneuvers. In fact, it brought me back to my medical school days in which I would very carefully observe an attending for every movement, like it was a magic show.
Dr. N called Lexi and put her collar back on. Then she asked me if I was willing to take a brief walk outside. It was refreshing to leave the clinic and go into the fresh air and sunshine. As I walked Lexi down the sidewalk, Dr. N squatted on the ground and trained her eyes on Lexi’s gait. First, she examined Lexi’s hind legs and then asked me to turn Lexi around so she could focus on her front legs. Dr. N then rubbed the palms of her hands together to warm them and placed them on Lexi’s right foreleg.
