Chief Complaint

The “chief complaint” (“CC”) is the reason a person seeks care on a given day.  If a patient presents with “headache,” we assume they want a diagnosis.  But sometimes there’s a deeper level of “CC.”  Maybe they don’t care what they have, and just want relief.  They might not even care about the headache, but a family member was sure they had a brain tumor.  Or they didn’t want to come in, but kept complaining about the headache, the family got fed up, & insisted they be seen.  Maybe the patient was on the verge of hitting a loved one, and bailed out to our E.R.  I’ve seen each of these examples.

My 85-year-old patient with history of MI & coronary bypass dropped in at closing time for an earache.  The ear was normal.  Well, he also had athlete’s foot (Rx given).  And his acid reflux was acting up.  Finally, with his coat on & hand on doorknob, one foot out into the corridor [literally], he spun around and clutched his chest, “I have chest pain!”  I should have asked.

A 65-year-old man arrived for his first-ever visit with a chief complaint of “epigastric pain of 10 years duration.”  That doesn’t make intuitive sense, so I inquired, why did he wait so long?   Had it gotten worse?  Did he mean he’d had it 10 years ago, & it just reoccurred?  Actually, he’d been uninsured, his Medicare had just kicked in, and he’d scheduled the appointment months before, desperate to finally get care.  Now it made all the sense in the world.

Usually the Chief Complaint is straight-forward, but always be alert to the real reason a patient seeks care.  Not infrequently, it may remain occult; if you can uncover it, it’s rewarding to everyone.

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