Trauma-Informed Medicine
Consider that history of present illness immediately follows your chief complaint.
Your encounter begins with a reason someone hopes to seek help.
You already have context of what’s in the medical record.
You have biases, preconceived notions, or the inkling you may or may not get the “truth”.
At this point, how could you re-frame your own thinking?
Do I need the story?
Do I need the narrative?
When we think of a “story”, we see it like a tale that may sound far-fetched, a tad difficult to believe, and outside the constraints of what we consider reality. There is the scenario of someone telling you that the ceiling fell on them suddenly, and an instinctual reaction that this sounds “crazy”. Did the ceiling suddenly collapse? How could this happen? Do I need a psychiatric consult? A natural line of thinking when you are on the job, and a list of tasks feels monumental.
Again, the story could be absolutely far from the truth, but your patient hopes to trust you with the reason they need help. As is the case for natural use, retrieval, and consolidation of short- to long-term memory, they will likely not remember, recall, and retrieve the exact sequence of events or timeline.
Give yourself and your patient the grace to delineate when the story is important, when the truth is important, and when the narrative matters. Maybe the ceiling did not actually fall on your patient, and this is the way they connect the truth to a story, which leads to a narrative.
In this case, the story and the narrative matter because you may need a CT scan now and not later.
