The Green Hornet wanted answers to each of the questions in his book. And he checked every last one...
About fifty years ago I was in medical school learning how to do a proper patient history. In the 1950's, medical students were marked as carefully on their patient histories and physical exams as they were in biochemistry or pathology. Most of the older medical school faculty I've talked with over the years believe that these skills - so essential to good patient care - were taken more seriously in those days.
At the time there was a very senior, older physician who went over every workup word by word and marked the papers we turned in with a green pen. He was a fussy guy and the workups were always so marked up when he was through, that generations of students called him the "Green Hornet".
We were given a small booklet that contained the questions every patient HAD to be asked when doing the history. They included a review of the Chief Complaint and History of Present Illness, which were both fairly straightforward. It was the Past Medical History and Review of Systems that got me into trouble one day with one very old, very deaf woman.
At the time, there were still large, open wards of thirty or forty patients in the hospital. The beds were separated by curtains that were drawn when the medical team took histories and did exams, and when the patient was having a procedure. But there was virtually no privacy.
It was my bad luck to be assigned one day to a very hard-of-hearing 91-year-old woman on one of these wards. I drew the curtain and started the exam, shouting questions like, "How many flights of stairs can you climb before you get out of breath?" These questions didn't elicit much response from the other patients, but as I worked my way down the Green Hornet's list to the "UG", or urogenital section, they started to get interested.
Health
I shouted, "How old were you when you started your periods?" and "Do you have a discharge? Could you describe it?" Finally I started hearing laughter from nearby patients, and shouting out the next questions to this little old lady seemed simply out of the question.
I should have known better.
It was visiting hour when I was sent back to finish my history.
Me: "How often do you have intercourse?"
Her: "What did you say?"
Me: "Is it painful?"
Her: "What's that?"
Me: "Sexual intercourse. Is it painful?"
Her: "What?"
Laurel and Hardy could not have generated such howls with this crowd.
And still, every time I see a write up that says "Review of Systems Non-Contributory", I think of the cheers that went up that evening when I opened the curtain and made my way back up the ward.
Dr. Richard Heilman is a graduate of the University of Pennsylvania Medical School in 1959 and is currently a retired professor at the University of Vermont College of Medicine.
