Tell me what troubles you most

The article by Donald Redelmeier and colleagues on eliciting an insightful history of present illness1 reminded me of a time, years before the advent of blank-cheque medicine, when I was called to a rural cottage, bare as a doghouse, the home of an elderly couple. Clean and impecunious, the old lady related that her husband had been bedridden for 10 days and that she was worried. During examination, the patient's responses to repeated questions were uniformly and charmingly vague. From his high fever, rigid abdomen and racing pulse, I surmised that septicemia from acute cholecystitis had brought him to a lucid period at death's door.

Trying one last time, I said, “Tell me what troubles you most.”

“Ah that I will know — let me see, ah yes, I would say, yes that's it, I've got that unsartin feeling.”