Author Thomas Merton in his autobiographical novel titled My Argument with the Gestapo wrote the following poem:
If you want to identify me,
ask me not where I live,
or what I like to eat,
or how I comb my hair,
but ask me what I am living for,
ask me what I think is keeping me
from living fully
for the thing I want to live for.
As a patient waiting to see my health care provider, I would adapt Merton’s template of personal revelation this way:
If you want to know who I am,
ask me not about my insurance plan,
or what is my current address,
or whether I have a POLST on file,
or whether I have signed the Notice of Privacy Practice,
or whether I'll accept a message on my phone --
but ask me what I am most concerned about,
ask me what I think is causing my symptoms
and what I think is keeping me
from eating healthy, exercising regularly,
and choosing moderation in all things
so that I can live fully
for the thing I want to live for.
As a physician in the midst of a busy clinic day, I struggle to know who my patients are beyond their standard medical history and demographics. One of my goals in our primary care clinic, now 16 years into electronic medical record (EMR) use, is creating a way for our patients to provide their personal history online to us via their password secured web portal. These are the questions our clinic staff may not have opportunity to ask or record during clinic visits. Having the patient personally document their social history and background for us to have in the chart — in essence, telling us their story in their own words — can be very helpful diagnostically and for individualizing the best treatment approach for each unique individual.
There needs to be an "about me" section in EMRs that would contain biographical and personal history information the patient could provide online via written text or video upload. Below is what that could look like:
Tell Us About Yourself
This is your own personal history in your own words to be added to your electronic medical record in the folder “About Me”. You can edit and add information at any time via this secure patient portal to update it.
We want to know your story. Only you can tell us what you think is most important for us as your health care providers to know about you. We may not always have the time to ask and document these detailed questions in a brief clinic visit, so we are asking for your help.
Why do we want to know your non-medical background as well as medical background?
We evaluate a patient’s symptoms of concern but we also are dedicated to helping our patients stay healthy life long. To assist us in this effort, it is very helpful to know as much about you as possible, in addition to your past medical history. It is crucial also to understand your family background and social history. We want to know more about your personal goals, and what you think may be preventing you right now from living fully for the things you consider most important to you.
This is your opportunity to tell us about yourself, with suggested questions below that you can consider answering. This information is treated as a confidential part of your medical record, just like all information contained in your record. You can add more at any time by returning to your own medical chart.
1) Tell us about your family—who raised you and grew up with you, and who currently lives with you– including your racial/ethnic/cultural heritage. If relevant, tell us whether you have biological beginnings outside of your family (e.g. adopted, egg donation, surrogate pregnancy, artificial insemination, in vitro fertilization) Provide information on any illnesses in your biologic family.
2) List the states or countries you have lived in, and what countries outside the U.S. you have lived in longer than a month. Have you served in the military or another government entity, like the Peace Corps?
3) Tell us about your educational and job background. This could include your schooling or training history, paid or volunteer work you’ve done. What are your hobbies, how do you spend your leisure time, what are your passions and future goals. Where do you see yourself in ten years?
4) Tell us about your sexual orientation and/or gender preference.
5) Tell us about your current emotional support system—who are you most likely to share with when things are going very well for you and especially when things are not going well.
6) Tell us about your spiritual background, whether you are part of a faith or religious community and if so, how it impacts your life.
7) Tell us what worries you most about your health.
8) What would you have done differently if you could change things in your life? What are you most thankful for in your life?
9) What else do you feel it is important for us to know about you?
Thank you for helping us get to know you better so we can provide medical care that best meets your unique needs.
What Other Questions Will Help Us Know Our Patients Better?
As our clinic is moving to an updated EMR, I’m interested in hearing feedback from patients and health care providers.
What additional questions would you want asked as part of personal history documentation in a medical record?
EMRs allow us to have the ability to share information securely between patients and their health care providers. Patients want to tell us their story and, in turn, we want to know more about them.
It is time we asked them.
Emily Gibson, MD is a family physician, farmer, poet, wife, mother, and grandmother. She has worked in inner-city primary care, community, and rural health, as well as detox and sexual assault centers. She has served as the medical director of a University Student Health Center for three decades. Both a photographer and writer, she shares daily about her life and work on her Barnstorming blog.
Dr. Gibson is a 2018–2019 Doximity Author.