In the following dialogue, a 52-year old male reports to the emergency department with chest pains. The man is on a stretcher. He is rubbing his chest with his hand. He is pale and looking anxious.
Health professional: Hi. Are you Mr. Jack?
Patient: Yes, Bryan Jack.
Health professional: Hi Mr. Jack. My name’s Martha. I’m one of the nurse assistants working here today. I see you’re in some distress.
Patient: Yeah, I’m having chest pains. My heartbeat feels funny.
Health professional: Okay, I’d like to ask some questions about the pain. When did it start?
Patient: A few hours ago.
Health professional: What were you doing when it started?
Patient: I had just left work and had stopped at the grocery store. Then I was driving home.
Health professional: Okay, while you were at work were you exerting yourself?
Patient: No, just sitting at my desk working at my computer.
Health professional: Have you ever had this kind of pain before? Any similar episodes?
Patient: No, never.
Health professional: And exactly where are you feeling the pain?
Patient: Right here, in the middle of my chest. It feels like someone is squeezing me tightly.
Health professional: Okay, if you had to rate your pain on a scale of one to ten, with one meaning no pain and 10 meaning the most pain you can imagine, what is it?
Patient: Oh, I don’t know. It’s pretty bad -- maybe an eight or nine.
Health professional: Okay, does the pain go anywhere else, like your arm or shoulder or your neck?
Patient: It’s mostly in my chest, but my left arm and shoulder hurt a bit too.
Health professional: Are you short of breath?
Patient: Yes, sometimes I feel like I need to take a deep breath.
Health professional: Do you have any nausea?
Patient: A little.
Health professional: Do you have any medical problems?
Patient: Yes, I have high blood pressure.
Health professional: Are you diabetic?
Patient: No.
Health professional: Any problems with your kidneys? Thyroid? Or stomach?
Patient: Only a bit of heartburn. I take antacids.
Health professional: Are you taking any other medications?
Patient: Yes, pills for my blood pressure.
Health professional: Did you take them today?
Patient: Yes, I took them this morning.
Health professional: Do you have any allergies?
Patient: No.
Health professional: Do you have any history of heart problems?
Patient: Yes, my dad died from a heart attack, he was 50.
Health professional: Okay. I’m going to check your blood pressure, start an IV, order some blood work and an ECG. The doctor will be in soon. Any questions or anything else you think I should know?
Patient: Can I get something for the pain?
Health professional: As soon as I get these things done the doctor will order something. In the meantime, I’ll start a bit of oxygen. It should help.
Teacher: Wow, a lot happened in this last discussion. Why did Mr. Jack go to the hospital?
Student: He was feeling pain in his chest. He wanted to have it checked out.
Teacher: That’s right. What kinds of questions did the nurse assistantant ask?
Student: Um, she asked about how much pain he had, where the pain was and if he was feeling sick to his stomach.
Teacher: That’s right! She asked about a few more things too…some questions about his medical history, can you remember any of them?
Student: Yes…she asked about medical problems, if he takes any medications…um…any allergies too.
Teacher: That’s good. She also asked about heart problems in his family and if he had any problems with his kidneys, thyroid or stomach.
Student: Oh right. Those are the kinds of questions we should always ask our patients, right?
Teacher: Yes! Knowing patient history helps identify current problems. After asking about the history, tests can help narrow things down.
Student: That’s right, she asked about taking some tests…blood pressure, blood work and an ECG.
Teacher: All these elements combined will help the doctor understand what is wrong and be better able to treat the patient’s heart problem.