COPING WITH THE MODERN ENVIRONMENT: TAKING THE MEDICAL HISTORY

The taking of a medical history also reveals the difference between ours and the traditional approach. Traditional medicine is centered on the body and its various organs. It is called anthropocentric, or body-centered, medicine. A traditional doctor is mainly concerned with treating the body and focusing primarily upon the most distressing physical symptom or “chief complaint.”

In the traditional history, previous medical problems will also be noted briefly, but in general there is no attempt to link seemingly unrelated “nonmedical,” past problems in the patient’s life to the present illness. Of course not— for no theoretical framework exists to make such connections. In general, symptoms and organs are neatly compartmentalized and viewed in relative isolation from one another. The history of a person’s illness is thus seen narrowly, as the history of one particular symptom or syndrome, rather than broadly, as a history of increasing ill health stemming from environmental exposures.

Although the dates of important medical changes may be indicated on the record, the reader of such a traditional medical history tends to be relatively unaware of the long-term progression of symptoms which may have preceded the current illness. In addition, traditional medical histories tell almost nothing about the environmental facts of a patient’s life. The doctor rarely asks about the details of job or hobby, about cooking or heating systems in the home, or methods of insect control used in the patient’s vicinity. To him, these seem irrelevant and outside the practice of medicine as he was taught it in medical school.

If currently available tests show no “organic” disease, the doctor is more likely to ask probing (and sometimes leading) questions about interpersonal relationships, such as problems with a spouse, children, or parents. Generally speaking, however, little effort is made to relate the “chief complaint” to other problems in the patient’s life, and the “medical” facts tend to be separated from the environmental facts.

The basic cause of a chronic illness is rarely exposed by this type of traditional history-taking. Since the doctor fails to comprehend the subtle and hidden give-and-take between the environment and the patient, with its ever-shifting balance of environmental challenge and individual response, he cannot understand the patient’s seemingly unclassifiable illness.

A patient with a long history and a thick file frequently becomes a “neurotic” in the doctor’s eyes, and this judgment is passed along from one doctor to another. In such an atmosphere, doctors tend to become cynical about many patients’ complaints, while patients bitterly reject established medicine.

I call this traditional approach the “ABCDs of modern mass-applicable medicine.” A stands for Analytical: the medical profession tends to chop problems up into neatly compartmentalized specialties, rather than seeing the broad outlines in a synthesized (unifying) fashion. B and C, in this scheme, stand for Body-Centered. The doctor looks at the body but fails to see the environment (mainly physical and nonpersonal) which impinges on that body at every step and with every breath. D stands for Drug-oriented. The traditional physician almost always uses drugs to alter or neutralize symptoms whose basic cause(s) he does not understand. Analytical, Body-Centered, Drug-oriented medicine has many achievements to its credit, but it offers little to the growing number of patients who are suffering from environmentally induced chronic illness.

The history-taking of clinical ecologists is quite different. Whereas in traditional medicine, the taking of the history (which is one of the most important portions of the diagnostic process) is usually assigned to the least experienced member of the medical team (the intern or medical student), the clinical ecologist himself usually conducts his own interviews. Some people think a doctor wastes valuable time by doing this. If important leads are to be uncovered, however, it is necessary for one experienced person to be familiar with the details of each individual case.

Because of the essentially addictive nature of many environmental problems, especially in their earlier, or stimulatory, phases, medical histories can be paradoxically misleading. For example, an untrained history-taker can overlook the significance of a patient’s remark that he “loves” or “craves” a particular food or chemical, and that eating, drinking, or inhaling that item makes him feel better. A conventionally trained doctor or nurse is likely to encourage the patient in the use of such a substance, while a clinical ecologist will immediately suspect it as a source of allergic/addictive responses.

The form of the interview which a clinical ecologist conducts is also different from that in traditional, ABCD medicine. Instead of looking at the body as a collection of various organs and parts, with medical and scientific subspecialties organized to deal with isolated problems which affect them, clinical ecology emphasizes the wholeness of the individual and the uniqueness of his experience. It thus forms part of the larger movement toward “holistic” medicine, which is gaining increasing importance.

Emphasis is put on recording events in a chronological fashion. The patient’s illness must be traced not just to the onset of the present symptom but to the beginning of his overall ill health. This, in turn, must be correlated with significant events in his life history.

Getting the medical history usually takes me about one hour. First, I generally let the patient explain who referred him and why he has come, in his own terms. If he has come because of a well-defined problem, such as headache, I ask him when he started having headaches and let him make any statement he wishes about this problem.

If the patient cannot single out any overriding problem but simply feels chronically ill, with many complaints, I ask him when he ceased being well and started feeling poorly. In other words, I try to orient the history (as the name implies) to the development of the problem in time. However, some people cannot give a chronological history. Either they do not think in those terms or their minds are too clouded by their disease. In these cases, I simply ask the patient to state all of his symptoms according to the categories explained in Chapter 8. Briefly, the categories are: physical localized symptoms: 1) upper respiratory, 2) lower respiratory, 3) gastrointestinal, 4) dermatological, 5) genitourinary. Physical systemic symptoms: 1) fatigue, 2) headache, 3) myalgia, 4) arthralgia. Mental-behavioral symptoms: a) brain-fag b) depression, with or without altered consciousness.

I gather in the data, typing whatever the patient says, without making off-hand interpretations. After about an hour, good clues usually emerge from this narrative, although the cause of the illness cannot be known for certain until actual testing is done.

The medical history is supplemented with forms and tests, such as the Chemical Questionnaire reprinted in Chapter 19. On the basis of the results of the interview, questionnaires, and tests, the patient is then assigned to one of two groups. One group, constituting about half of my referred practice, are patients who are so seriously ill that they must be hospitalized to undergo further testing and treatment. The method of helping such patients is explained in the following chapters. The less severely afflicted, or those who are unable to be hospitalized for a variety of reasons, are diagnosed and treated on an in-office (outpatient) basis.

*92\110\2*

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