|A good doctor would
always take the history first and then examine
the patient. Since in case of Arab patients,
there is a language problem, there is tendency to
omit history and examine the patient
straightaway. The general feeling amongst the
doctors is that very little can be missed in
these days with availability of modern imaging
investigations and multiple blood tests like
SMA-12/60 by auto-analysers.
I shall quote a few
examples of Arab patients seen in my clinic,
where the main diagnosis was missed elsewhere
because of reliability on machines!
- A few
Bahrainis (non-English speaking) in whom
was missed because the resting
electrocardiogram was normal which as we
all know is the case in over sixty
percent of such patients. Stress test was
not asked for, because history was not
Asthma and allergic bronchitis were
missed because X-ray chest was normal.
stone, seen on plain X-ray of Abdomen was
being treated when patients' symptoms
were due to "Peptic
stones were blamed when the symptoms were
due to straight-forward, severe irritable
of peptic ulcer were diagnosed to be due
to chronic hepatitis, because the
auto-analyser report showed a few
abnormal liver function tests and the
liver scan showed a patchy uptake of the
has been diagnosed as having
- Peptic ulcer
(reported on a routine barium
meal examination) and
- Kidney stones
(seen on routine X-ray K.U.B. and
l.V.P. Examination) and
(reported on routine stool
(which was in fact a slight
glucose intolerance) and
hernia (detected on clinical
when in fact his main aim of coming abroad was
for treatment of his sexual weakness.
I can go on
enumerating a number of examplesall of them
to show that in a clinic, the time spent on
history taking is the most important part of the
comes the situation where the history is elicited
through the interpreter. However well trained the
interpreter is in his language, he is more fit
for colloquial, non-medical speech. For taking
medical history, he is no good.
interpreter is usually looking at his watch and
is always in a hurry for his next appointment. In
case the interpreter is a relative or a friend,
then, as is the usual habit of all the people,
after hearing the patient, he twists the whole
story according to his own taste, wisdom,
prejudice, common sense and style of
presentation. If at all an interpreter is used,
he should be forced to translate patient-doctor
dialogue line by line and even word by word.
always worth knowing, from which part of the Arab
world the patient comes. Thus conditions like
"Functional Arab Syndrome"
described elsewhere, become a "spot"
diagnosis by asking leading questions. Also the
age of every patient should be asked. Do not
guess. You could go wrong. The beautiful
artificial dentures (golden teeth included),
artificial eyes and use of hair dyes even on
beard and moustache can be misguiding!
about all the Arab patients, specially Yemenis.
They use the anatomical words of the organs while
giving the history. It is so common to hear them
saying, "I have pain ("Wajaa")
in my heart ("Gulb")my
are painful ("Awar")I
have pain in my stomach ("Maidaa")
or liver ("Kibid")".
taking history, this tendency of using the names
of the organs should be discouraged. If he says
"I have high blood pressure" ("Dhakht"),
it is probably giddiness. Often he would say
"I have an ulcer ("Garhaa")
of the stomach". Tell him to explain his
symptoms and it turns out that he is suffering
from colicky pains ("Ikfahas")
due to irritable bowel syndrome. Still many would
use the word "Fooaat",
which has multiple meanings in different
subcommunities in Arabs.
habit of an Arab patient is that he starts with
the details of past illness first, and by the
time he comes to his present complaints, the
doctor is already bored, biased and confused. To
avoid this situation, always ask him "What
is your present ("Alhain")
complaint ("Aish Takleef")?"
population, however, illiterate, knows the
'names" of so many diseases which other
patients hardly ever know. If the past history of
following illnesses is asked for, often the
answer is 'yes'.
with urinary or bowel complaints (often
in Yemenis)pronounced as "Bilhaarzia".
as G for goat"Giardia")
or dysentery (pronounced as "Aamoeba
in stools ("Dood fil
KHaruj" or "Albraaz")
operation ("Dood Zaidaa")
stone operation ("Kiliya",
Bahrainis, Saudis and Qataris, do not forget to
ask for family history ("Fee
Aeelitik") or past history of
high blood pressure ("Dakht")
and diabetes ("Boal Sukkar").
I n Yemenis, it is worthwhile asking for a past
history of Kochs ("Sil").
elicited in detail.
cigarettes is universal in Arabic countries.
Arabs who can afford to spend for "filter
cigarettes" or "long tip
cigarettes" easily fall prey to the
advertisements. Many Arabs specially young,
become heavy smokers thinking that they are
protected by "filter". Some elderly
women in Bahrain, Qatar and Saudi smoke Hooka
known as "Sheesha"
in their countries. In a female patient with
chronic cough this should be kept in mind, though
as mentioned elsewhere, it is not so common.
and Arabic coffee ("Qahwah")
Most of the
Arabs would consume 2 to 6 or more cups of tea
per day. But when it comes to "Qahwah",
it is often 10, 20 or 30 times a day! Although
they would insist that the quantity they drink at
a time is very small (which is a fact), it is a
about consumption of whisky ("Wisky")
or beer ("Bir")
should be found out. In Bahrainis the answer is
You have then to enquire, "how often and how
much". Unless asked in such details, many
would not talk about 2 to 4 cans of beer which
they consume in the afternoonespecially the
young population. However, most of them are
countries like Kuwait and Saudi Arabia, it is
nearly impossible to obtain alcoholic drinks. In
Oman and U.A.E., it may be possible to procure
them. In Yemen, alcoholic drinks are easily
Hashish and other intoxicants including tablets
mentioned in the preface, should be elicited.
Hard addicts of Hashish or barbiturates rarely
come for treatment. The use of "Qat"
needs special mention. Nearly the whole Yemen
populationmen, women and grown-up children
toohas tasted, heard of or used it
regularly. In North Yemen, it is still sold
freely. In Democratic Yemen, the Government has
restricted the sale to twice a week. yet there
are many people who use it daiIy or a couple of
times per day. An average Yemeni reminds me of an
underweight Maharashtrian policeman seen in
Bombay who will be seen stuffing "Tobacco
leaves" in his oral cavity in between the
buccal mucous membrane and the gums. The
secretion which is swallowed constantly peps him
up with energywhich lasts for a couple of
hours. Then he needs a "refill".
Yemenis use "Qat"
in the same manner. Many Yemenis serving in Saudi
Arabia miss "Qat".
different types of "Qat"
availablecostly, moderate or cheap, for sex
stimulation or intoxication. Most of the times
"Qat" is used
for experiencing euphoria and hyperactivity,
especially when groups of friends (men or women)
meet on week ends (Thursdays and Fridays). Many
people in service, use this stuff daily to
increase their work output or may be, to relieve
themselves of tension ! "Qat"
is not available in or used by Gulf or Saudi
population. Some symptoms e.g. severe
constipation, dryness of the mouth may be due to
atropinelike action of "Qat".
points in personal history regarding urine,
stool, sleep and sex should be recorded.
If an Arab
patient is asked a leading question, "Do you
sometimes or off and on ("Aao
of urinehis answer is usually
"yes" and if he is a Yemeni, it is
Most of the
Arab population is constipated. Many of them have
bowel movement once in 2, 3 or 4
daysespecially females. But in Yemenis, it
is common to have history of weekly evacuation if
not every 8 to 10 days! Also the faeces are often
very hard ("Yeboosaa")
Arab patients, specially Yemenis, the sleep is
not satisfactory. Dreams ("Halaam")
are so common (though often not frightful) that
they leave the patient exhausted ("Taihbaan")
and weak ("Daaeef")
in the morning when they wake up.
Sex must be
inquired into detail even if the patient is 80 to
90 years old. "Jahaaz"
or "Juma" is
a decent word for all. But for young Arabs, the
colloquial word is "Zib Mazboot",
which literally means, is your penis strong?