No this isn’t about an audible floor vote in Congress where ayes and nays make the difference in legislation and the Speaker pounds the gavel and pronounces “The ayes have it!” This is about a physician’s ability to make a diagnosis while taking a history from a patient. Let’s face it (no pun intended), when it comes to that all important decision about what is really ailing a patient, I am strictly “old school.” I was taught long ago, in the late 1950s, to look a patient straight in the eyes when asking a question and deciphering his or her answer. You can learn a lot about a person that way. Is what they are saying the real reason for their visit, or is there something deeper that is getting them to seek your advice as their personal physician? Some are secretly fearing that they have cancer, hiding depression or simply wanting to be reassured about some imagined problem. When I am looking for the answer, I have learned through more than fifty years of experience, the eyes have it. They can tell you about diabetes, hypertension, obstructive liver disease, a stroke or brain tumor and much more from a physical perspective, but looking a patient directly in the eyes can also tell you something about what they are really thinking deep in the soul.
Unfortunately, in this new world of electronic medical records, doctors are being asked to strum over a key board while they sit facing a computer instead of you or me, the patient. As they inquire about our symptoms and receive our answers, they type on but never look up. When they have examined you or me they go back to their lap top and bang away with their findings. As the patient sits in a cold sweat awaiting the doctor’s opinion, that physician is busy running rabbit trails through the questions that the computer is asking to be answered.
One of my mentors in medical school, a brilliant clinician and teacher on the subject of internal medicine, once told me, “If you ask your patient the right questions and follow up with more right questions based upon their answers, you will make the diagnosis 90% of the time. But always keep this in mind; their eyes may tell you more than they say verbally.” Being a highly educated man he had undoubtedly read of Heraclitus of Ephesus, a Greek philosopher (540-480BC) who said: “Eyes are more accurate witnesses than ears.” It is truly an ancient axiom, the eyes have it.