Careful History and Physical
Doctors and patients alike are getting very tired of the current insurance-driven medical system which often allows doctors only 8 to 15 minutes per patient. It is simply impossible to do a comprehensive history and physical in that length of time. But with complex chronic environmental illness, a comprehensive history and physical are essential, as much reliance must be placed on detective work. Sometimes, it’s the mold in the wall, or the new carpet at work, that is making a person sick. Most people don’t think of such things on their own; the doctor and patient have to dig into many details to find the cause or causes of a patient’s illness.
That is why we approach office medicine differently. Most new patients get at least an hour. Many get more, depending on the issues to be considered. During that time, the patient tells his or her story in as much detail as possible. We review the multi-page history form (which delves into many issues which are often ignored but sometimes very significant). (This form is mailed out ahead of time because of its length.) We discuss possible problems in as much detail as needed. (The goal is patient understanding.) Then the physical exam allows us to focus on specific issues – dental issues, for example, or neurological.
Following that, a diagnostic and treatment plan is put together, and discussed with the patient. Diagnostic tests are kept to a minimum, in part because of expense, in part because Dr Bernhoft believes a test should not be ordered if it is not going to change treatment.