I am forever floored by the sheer number of patients that are unable to effectively communicate.  When I go see someone, I generally start off with an open-ended question like “what brings you to the ER,” then move on to a series of yes/no type follow-ups.  Maybe 1 patient in 10 manages to consicely describe their issue and stick to yes/no answers.  The rest fall out into at least one of the categories below.

Mom of 14 month-old girl: “She’s had vomiting and diarrhea all day.”
Me: “How many times has she thrown up?”
Mom: “Probably at least 30.”
Me: “And diarrhea?”
Mom: “The same.”
Me: “Is she keeping anything down?”
Mom: “No it’s all coming back up.”
Me: “How’s she acting at home?”
Mom: “Laying around, real lethargic.” 
Me: [Looking back at drooling content-appearing baby] “Huh.”

All I know, exaggerator, is that your daughter’s appearance in no way matches your description.  Maybe you’re so worked up your sincere perception is worse than reality.  Maybe you’re afraid I won’t take you seriously unless you do a little embellishing.  Regardless, we’re not making a Lifetime movie here.  No dramatic licence necessary, let’s just stick to the facts as they are.

45 year-old hispanic patient: “I’m dizzy.”
Me: “Dizzy means different things to different people.  What is it exactly that you’re feeling?”
Patient: “That I’m dizzy.”
Me: “So some people say they feel like the room is spinning, some that they feel like they are going to pass out, some that they’re off balance, some that they feel weak everywhere.  How would you describe yours?”
Patient: “Well…I guess…it’s sort of like…I don’t know I’m just dizzy.”

The ill-depicters cannot come up with the necessary words to elaborate on what they’re experiencing.  More often than not this is due to some sort of language or cultural barrier.  Nonetheless, when I can’t narrow down your problem I’m left to scatter shoot with a big compensatory million-dollar workup.

Me: “When did your chest start hurting?”
55 year-old male patient: “I don’t know it was nothing.”
Me: “How bad was it?”
Patient: “Hardly even noticed — it was probably just some gas.”
Me: “Then why did you come in?”
Patient’s wife: [rolls eyes] “He was clutching his chest, sweaty, and said he felt like he was going to die.” 

I know you’re only here, stoic dood, because your wife made you come.  Still, now that you’re here I’m charged with your care and liable if I miss something so please do me the favor of shelving the disinterested tough guy act for five minutes or so.

Me: “When did this start?”
48 year old female patient: “A while ago.”
Me: “Can you be more specific?”
Patient: “Oh, I really can’t remember.”
Me: “Maybe you can narrow it down a little bit?  A day ago?  A week?  A month?  A year?”
Patient: “I guess after I got back from Hawaii.”  

At this point, with vagueurs, I usually just put on my robe and wizard hat.

Me: “Do you take insulin or pills for your diabetes?”
Patient: “Well, at first they put me on a diet, and told me to exercise, and I did for a few days anyway and at first it seemed like maybe it helped a little bit, but then I guess it got worse, so they put me on a pill…what was it called…metop-o-nin…metamucil…formethorin…no…metlife?”
Me: “Metformin.”
Patient: “Yes!  Metformin!  So anyway they put me on that at first and I was getting it filled and then there was a problem with my insurance so I had to switch to a different pharmacy and that one was way farther away and the people there were not nearly as nice, except for Lula although now that I think about it she didn’t even work there, she worked at the Marshall’s across the street — I think it was a Marshall’s, either Marshall’s or Ross I can’t remember, which reminds me I need to take those shoes back, um, so…uh…where was I now?”
Me: “Um, insulin or pills?”

Wanderers are the worst.  I usually end up afraid to ask any more questions and cut the conversation short.

Me: “What brings you to the ER?”
19 year-old female patient: [rocking back and forth] “omg omg omg omg gasp sob omg”
Me: “Hey!  Get ahold of yourself.  What’s wrong?”
Friend: “She got in a fight with her boyfriend and now her whole body is numb.”

Hystericals, pull yourself together and have a little self-respect. 

Me: “Have you had fever?”
Patient: “No, but chills.”
Me: “Vomiting?”
Patient: “No, but I feel like I need to.”
Me: “Surgery on your belly?”
Patient: “No, but I’ve had my tonsils out.”
Me: “Heart problems?”
Patient: “No, but my mom’s a diabetic.”

The no/buts cannot bring themselves to stop at no.  Do I need these extraneous details?  No, but my knee is a little achy today.

Me: “Your chest hurts?”
Patient: “Oh yes.”
Me: “Short of breath?”
Patient: “A little bit.”
Me: “Dizzy?”
Patient: “Very.”
Me: “Vomited?”
Patient: “Twice.”
Me: “Is your 4th toe numb?”
Patient: “It tingles.”
Me: “Do your teeth itch?”
Patient: “They’re a little scratchy.”

On the other hand, the positive review of systems cannot bring themselves to even say no.  Everything = nothing though, I just put all these unlikely disparite symptoms in the chart allowing all future medical providers to read between the lines. 

So in conclusion,