Don't judge a book by its cover

Few patients around these parts are clued up about their health care. They usually don't have any idea what medical conditions they have or what medication they are taking and why (patients on ARVs tend to be the exception, but even they can't usually tell you on their first visit what other medical conditions they have). Add to that that there is usually a language barrier, and taking a history can be difficult at best in South Afican hospitals. I have an interpreter at my disposal these days, but back in my student and intern days it took very long to figure out why a patient was presenting. I would often hit a snag at the second question "How old are you?"("What is your name?" would usually go off without a hitch). Back in medical school it took all of us a little while to figure out that when we asked a patient their age, they were giving us the year in which they were born instead. None of them actually knew how old that made them. They would say "64" meaning 1964, but we didn't know that at first and we'd say to each other " but he doesn't look that old". It was a waste of precious time in short cases in clinical exams when you'd have to waste 2 of your 15 minutes trying to figure out how old someone was when you could have been asking them important stuff (like what their dog ate ;))

I saw this patient a while back. He didn't speak English to me so I used an interpreter to take his history. He had a miriad of complaints, none of which I can remember now because none of them were very serious. When I examined him, I noticed he had a rash which looked suspiciously like a drug induced rash. I asked the interpreter to ask how long he'd had it and whether he'd been taking any medication before it started. He answered her in Swazi. I said out loud "This looks like a drug rash". He looked at me and said "It was a Stevens-Johnson syndrome that was caused by TB treatment. I was in hospital for about a week and then it got better."