In medical school the family medicine folks are in charge of teaching you how to get a nice, detailed history from the patient. They mention things like not interrupting, letting the patient tell their own story, asking open-ended questions, and so on.

The ER, although a very different setting from a family medicine office, actually likes lots of details in the history. If you don’t ask when the last meal was, who the primary care doctor is, when they were last seen, how much they used to smoke, you can be sure the attending will want to know about it, and have some reason why it’s important.

But there are special circumstances:

Elderly male, well-known lung problems, brought in by squad, short of breath. He’s not a healthy color, clearly struggling to breathe (you can see all the accessory muscles). The resident is dutifully attempting to get a history: when the problem started, what makes it worse, when was he last hospitalized. The attending walks in, takes one look at the patient, one look at the monitor (tachypnea, sats in the low 80s), and says: “There’s only one important question here: ask him if he wants everything done.” The man says yes. “Then call respiratory, because this isn’t going to last much longer.”

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