Why Is Taking a Good Patient History So Important in Treating TBI?


Why is taking a good patient history so important in treating TBI?


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[Dr. Heechin Chae] History is very important. Actually, that's what you rely on to diagnose or develop a treatment plan for the patient. You have to take time. I feel like I'm a detective when I see my patient because not only do I have to carefully ask the right questions to the patient, I have to verify some of those questions. Not because I don't trust that person, but TBI concussion, by definition, is loss of memory. It's alteration of consciousness, and you don't really remember exactly what happened or at least the details are supposed to be fuzzy. If somebody tells me a second-by-second playback of what happened, I start to think, "Okay, maybe the person did have a concussion," because that's almost impossible if you did have true TBI concussion. So I have to verify with the people that witness, hopefully, the event. The medical personnel that came to assess the person when they were called—if they were called— follow the medical-treatment event after that incident. So that's one factor—medical record review. Then I have to interview somebody that knows that person because concussion TBI, by definition, is that you act differently or you think differently—there's something different about you. People who don't know you may not tell, but people who know you say, "There's something wrong about you. There's something different. I don't know what's going on, but you're not the same." So I need to ask people who know my patient well. "Is there anything different about this person?" So that interview is important. And then lastly, I have to find out all kinds of history, like family history. Is this person at risk for depression? Is he at risk for a neurodegenerative disease? Is he at risk for seizures? All those things that, again, can happen with some injury or even temporary injury like concussion TBI. The brain can lower the threshold and clinically manifest. So that's why it takes time to interview and assess those things for my patient.
Posted on BrainLine September 10, 2013.

About the author: Heechin Chae, MD

Heechin Chae, MD was appointed site director of DVBIC at Fort Belvoir and chief of the Traumatic Brain Injury Department at Fort Belvoir Community Hospital in 2011. He will become the director of the National Intrepid Center of Excellence satellite at Fort Belvoir in 2013.

Heechin Chae

Produced by Victoria Tilney McDonough, Lara Collins, and Ashley Gilleland, BrainLine.