By Dr. Anthony Policastro

One of the most important parts of evaluating a patient is taking a medical history. The questions vary with the presenting symptoms.

Sometimes, the questions can be embarrassing. For example, a standard series of questions for a female adolescent with abdominal pain relate to whether she might be pregnant. Parents are often upset if the physician asks questions about sexual activity. They know that their daughter cannot possibly be pregnant. So why must we even ask the question?

Sometimes the questions can appear to be unrelated to anything. That is because the physician might be considering a diagnostic possibility that the patient does not know about. 

A good example of that is a condition called G6PD deficiency. These patients often come in with odd symptoms. Sometimes the symptoms are related to a reaction to eating fava beans. Patients may question why they are being asked about their dietary habits when they have no GI symptoms.

For the last year or so we have a new phenomenon. The COVID epidemic has added a series of questions to the history. They include whether or not there are COVID type symptoms. They include whether or not there has been COVID exposure. They include vaccination status.

There have been multiple instances where patients who oppose vaccination get upset with the medical staff for even asking the question.

There was one instance of a man becoming so belligerent that he had to be removed by police. He then called the hospital operator to say he was coming back with a gun.

There was another instance of an individual who walked out to the ER parking lot. He grabbed a bunch of rocks and came back in throwing them at people.

Medical staff are used to patients blaming them for things. Illness is viewed as a loss. It is associated with grief. One of the stages of grief is anger. That can be directed at medical personnel.

However, that usually comes with a diagnosis that the patient does not like. It is seldom related to questions that the patient gets asked upon arrival.

People need to realize that they may not know why the questions are being asked. They need to realize that anger is not productive. They need to treat everyone, not just medical staff, with more respect than they often do.

COVID update- Last week I discussed the updated CDC guidelines. The focus is now on COVID-19 hospitalizations as opposed to total number of COVID-19 cases. 

This week the number of inpatient COVID-19 cases is low enough that we have moved from a medium risk area to a low risk area.

The numbers are such that we are just below the threshold for medium and barely into the low area. However, those numbers are likely to continue downward.

On a practical basis that leaves two CDC suggestions for individuals in the county. The first is to stay up-to-date with COVID-19 vaccines. The second is to get tested if you have symptoms. 

Going from medium to low removed the suggestion that you should talk to your healthcare provider about whether to wear a mask and take other precautions if “you are at high risk for severe illness.”

Mild cases are not as relevant as severe cases. At home testing kit positive results are not reported to anyone. Therefore, total case counts are not as relevant.

For those individuals still fascinated by the total number of cases, the national numbers have decreased from 480,000 last week to 380,000. Sussex County’s number of new cases has dropped from 328 last week to 170 this week. 

Both national and local levels are the lowest they have been since the end of July.