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Female doctors holding her patient's hand

20 Questions Doctors Should be Asking Patients with Chronic Illness

Health is about so much more than our bodies. On top of the standard medical history template, doctors should also be asking these questions.

Our bodies are a canvas on which our thoughts, beliefs, past and current experiences leave an impression. The state of your body today is a culmination of what has gone before. So, when your body is not at its biological best, it’s really important to delve into why the disruption has happened. The standard medical practice of taking a patient history is made up of the following structure.

The presenting complaint – what has the patient come in about today?

The history of the presenting complaint – when did this complaint start and are there any other details relating to it?

The past medical history – what other diagnoses does the patient have?

The medication history – the list of current prescribed medications.

The family history – what illnesses run in the family?

The social history – is the patient employed, who do they live with, do they have pets?

The allergy history – is the patient allergic to anything?

This is what doctors are taught in medical school. This is what you have to ask. There is nothing in this globally used template that actually asks about how a person feels, what pain they carry or what life experiences they have had.

A patient is greater than the list of illnesses they have, or the medications they take. A patient is more than their blood pressure, x rays or pathology results.

Dr Seema sitting at her desk in a remote Aboriginal medical clinic

I work in an Aboriginal community in North West Australia. Indigenous people have suffered major intergenerational trauma. There has also been a recognition in recent years of the extent of sexual abuse suffered in institutional care during the time of The Stolen Generation, when Aboriginal and Torres Strait Islander children were forcibly removed from their families as a result of government policies at that time. Today’s government is trying to make reparations for the past through The Redress Scheme, which offers financial compensation for victims of abuse. My clinic has commenced the practice of gently asking all adult patients, female and male, if they have been victims of abuse. 

It is estimated that a quarter of all adults have been physically abused as children. And international studies suggest 1 in 5 women and 1 in 13 men having been sexually abused as a child. 

In Scotland, the National Health Service has acknowledged the impact of financial stress on the health and wellbeing of individuals by developing financial inclusion referral pathways. 

GPs are supported to ask their patients about their financial situation and patients who are struggling can be referred to financial services for free support and advice on topics such as how to maximize income, how to manage debt and how to make a budget.

Woman sitting on the ground with her knees up looking depressed

There are many ‘off script’ questions I ask my patients. Some of them bring up painful memories. But as a doctor, it is really important for me to know the life of the person sitting before me, what has shaped their experience, and what history may be contributing to their physical and mental health today. Only then can I help them properly or direct them to services that are equipped to support them. What has stunned me is firstly just how many people have suffered from trauma, non-indigenous as well as First Nations people. But secondly, for the majority of patients, I will have been the first person who they have ever talked to about something that happened to them years ago. Not everyone wants to talk, but for so many, it is a relief to get it out, to have just been asked. 

After getting permission to dig a bit deeper, these are my twenty questions for patients.

  1. Did you experience any childhood trauma?
  2. Did you feel loved as a child?
  3. What example did your parents set for you?
  4. Are you a victim of sexual abuse?
  5. Are you a victim of emotional abuse?
  6. Are you a victim of physical abuse?
  7. Have you experienced any major grief or the loss of someone you loved in your life?
  8. Are you harbouring any anger or resentment towards a particular person or situation that you are having difficulty releasing?
  9. How would you describe your relationship with your partner (and if you are single is there a particular reason for that)?
  10. How would you describe your relationship with your children (and if you have no children is there a particular reason for that)?
  11. Do you have any major regrets or unfulfilled dreams?
  12. What are your finances like?
  13. Are you employed and if so, do you enjoy your job?
  14. If you are unemployed what is the reason for that?
  15. What do you do for enjoyment?
  16. What do you do for self-care?
  17. Do you have someone whom you feel you can rely upon?
  18. What are your strengths?
  19. What are your weaknesses?
  20. What five words would best describe the way you feel about yourself?
 
 

Being a health professional is a position of great privilege. People let us into their lives, they trust us, often they put their faith in us to heal them. For some, the doctor’s office might even be the only safe space they know. Thank you to all my patients for helping me to understand people better and for teaching me so much more than what I could learn from a textbook. 

If you have anything you want to ask, or if there’s a topic you’d like me to write about just let me know.

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