May 28th, 2015
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The Virtues of Irrelevance Interesting belt where did you get that?I see you are from Youngstown. The key question is, are you a Steelers fan or a Browns fan?These are not the usual opening questions we teach for the medical interview. The answers are not included in the chief complaint, history of present illness, past history, social history, family history, review of systems, medications, or allergies. There is no hat or belt section in the physical exam. Differential diagnoses on sports, clothing, or food preferences are not a highly valued component of clinical reasoning. But often these opening comments and questions are the most important. They can be our tickets and our guides, ways to establish the connections that allow us to actually care for the person in front of us.We believe that these irrelevant opening comments and questions serve four key purposes. First, they convey that we see the patient as a unique individual. Given the speed of medical practice, it is not surprising that patients worry that their individual concerns will not be heard. Second, these questions reveal that we have had shared experiences, that despite our training an

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