| Affiliation |
(AGL) Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, Texas; Professor of Ophthalmology, Weill Cornell Medicine, New York City, New York; (PD) Class of 2021, Baylor College of Medicine, Houston, Texas |
| Transcript |
So, this is Past Medical History, Part 2. In Part 1, you heard about lung carcinoma, but really any kind of cancer, we need to know stage, grade, treatments, and side effects of treatments. In Past Medical History, Part 2, we also need to do the same process for medical conditions. So, you probably were told to record whether the patient has diabetes or hypertension or hyperlipidemia. This is a standard past medical history list. But what you really are trying to do is stratify this risk: how likely is it that whatever the patient is here for is due to one of these problems? And so, for hypertension, we would like to know what their last and current blood pressure is. For diabetes, we'd like to know what their hemoglobin A1C is. For hyperlipidemia, we'd like to know their numbers and whether they're currently on treatment, for example, statin therapy. Because if you just write "hypertension," "diabetes," and "hyperlipidemia," you really haven't stratified the risk of whatever their neuro-ophthalmic problem is as causing, or being caused by, their past medical history. And so, in every patient who I see who has medical problems, we check on the control, is it well-controlled or poorly controlled? We correlate their disease with their med list because the patient might even deny that they have any of these disorders. You might say, "Do you have hypertension?", they say "No," "Diabetes?", "No", "High Cholesterol?", "No". But then when you get to their med list, they're on lisinopril, and the statin, and metformin. And when you ask the patient, "I thought you said you didn't have these diseases", they might say something strange to you, "I don't have those diseases because they're treated." And so, there's a disconnect sometimes of what patients think is their past medical history and what their actual past medical history is. And one of those things we can do to reconcile that is looking at their med list and correlating it back to their past medical history. So in summary, in Past Medical History, Part 2, for medical problems, not only it is important to know what they have, but how well is it controlled and what treatments are being given so that we can risk stratify these risk factors for whatever the patient is complaining about. |
