Doctor's 'Worst Ever' Headache, and Learning the Patient Story

Nov. 15, 2011— -- Three months ago, at the age of 40, I had a small bleed in my brain. My story is no more special than any of your stories, but I learned something important from it and I want to share it with you. I learned firsthand the difference between what a patient tells his doctors and what he tells his loved ones, and why it matters.

When I arrived at the emergency room, I knew what data my physicians needed, because I'm a physician. I knew they would write an official note that tells the story of the patient's symptoms and why they sought care. This is called the History of Present Illness or HPI. As I gave the doctors my HPI, it went something like this:

"I was running hard on the treadmill at 5:15 p.m. when I suddenly got a headache. The headache was not relieved by rest and I noticed some neck stiffness. I had been feeling totally well until the headache started; no fever or other reason to suspect meningitis. Within 30 minutes I started vomiting and had sensitivity to light. At no time did I notice any numbness, weakness or other neurological problems."

This is an excellent HPI: short and to the point. But the story I told my loved ones was different.

"I was running hard on the treadmill when I suddenly got a headache. It surprised me at first but I figured I was probably dehydrated. It didn't go away after I rested for a few minutes and drank water. I noticed that my neck was stiff, but I knew it wasn't meningitis because I felt great until the moment the headache started. You know, most doctors are taught that if a patient says "the worst headache of my life," then it's a subarachnoid hemorrhage until proven otherwise. That means a bleed in the brain, usually caused by a ruptured aneurysm. But I knew something like that couldn't happen to me. And anyway, while I suppose technically this could be the worst headache of my life, it really wasn't that bad. I mean, technically everyone has had the worst headache of their life, right?

"I took a shower and didn't feel any better. Then I felt like throwing up. I didn't have to, but had that feeling that letting it out would make me more comfortable. Throwing up didn't help at all. I called my wife: 'Hi babe, I was going to suggest that I pick up the kids from my parent's house since I drove today, but actually, can you ask them to bring the kids home? I think I need you to be home when I get home, I'm feeling sick.' The drive home was a battle to not throw up again, and boy, was the sunlight making my headache worse.

"I could barely say hello to my wife, went straight to lie down, to try to get comfortable. No luck. Where is that pain coming from? OK, I'm not in control anymore, I can't be the doctor. I called my friend who was working in the urgent care. I started to explain but seconds later had to go throw up more. 'Just come in, we'll take care of you and figure out what's going on,' he said before I left the phone. My wife drove, I sat with a bucket between my legs. The retching was making my head hurt so much.