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COMMENTARY
Year : 2021  |  Volume : 4  |  Issue : 3  |  Page : 1-2

The “saptapadi” principle: The “open sesame” of history-taking


Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Date of Web Publication02-Nov-2021

Correspondence Address:
Dr. Sanjay Behari
Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJNO.IJNO_400_21

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How to cite this article:
Behari S. The “saptapadi” principle: The “open sesame” of history-taking. Int J Neurooncol 2021;4, Suppl S1:1-2

How to cite this URL:
Behari S. The “saptapadi” principle: The “open sesame” of history-taking. Int J Neurooncol [serial online] 2021 [cited 2021 Nov 27];4, Suppl S1:1-2. Available from: https://www.Internationaljneurooncology.com/text.asp?2021/4/3/1/329795



During residency, every medical student is subjected to hours of bedside teaching on the “science and art of history taking.” Over time, the entire sequence of “presenting complaints, history of present illness, past medical history, drug history, family history, and social history” becomes firmly entrenched in one's mind. Yet, every resident recalls the disconcerting situation of having spent hours trying to elicit history and then discovering that sincerity, empathy, and patience notwithstanding, the patient was less than forthcoming regarding most ailments that he/she meant to share the information on. Things really come to a pass when it takes <5 min for the consultant to elicit the same missed details of history from the patient and then shake his/her head in silent disapproval at the resident's incompetence in carrying out this seemingly simple task. Even when one becomes chairperson of a department, one often gets the sinking feeling after a session of history-taking with a patient that, “I am not there yet!” What has gone wrong each time? What is this “magical mantra” that every doctor yearns for and hopes had been imparted to him/her at the beginning of one's clinical career that would have enhanced the value of information obtained following the agonizing hours of effort at history-taking?

Consider two seemingly paradoxical yet true statements from the patient's perspective: (1) What is more mesmerizing for a person than to talk about oneself? (2) What is more embarrassing for a person than to divulge personal information about oneself?

What is the missing link between the two statements? The missing link is that the patient would love to talk about himself/herself but not with a stranger!

In conventional Indian weddings, the couple being married circumambulates the sacred fire seven times adhering to the “saptapadi” (the seven steps) tradition. This tradition emanates from a beautiful mythological story of a young couple, Sathyavan, and his devoted wife, Savithri. Following Satyavan's early demise following their marriage, when Lord Yama, the God of Death, departs with his soul, Savithri keeps following him. When Lord Yama realizes that Savithri is on his trail, he orders her to turn back. Undeterred, Savithri refuses and replies, “It is said that when two persons walk seven steps together, they become friends. We have walked many more steps together. As a friend, therefore, I ask you to return my husband's life and soul.” Lord Yama, impressed with Savithri's presence of mind as well as devotion toward her husband grants her wishes. Thus, walking “seven steps” with, and therefore, befriending the God of Death, she brought her husband back to life.

The Art of Living Foundation in their article “Saptapadi: All that you need to know about the seven steps of marriage” describes the “saptapadi” tradition that encapsulates seven vows that the newly married couples undertake with the seven “steps” or circles around the fire: (1) To provide for each other; (2) To look after each other's physical and mental needs; (3) To have affection for one another; (4) To be lifelong companions; (5) To grow together; (6) To look after children, family, and society; and, (7) To adopt a noble bent of mind. These seven vows are undertaken before the married life starts.

Similarly, the seven steps that would enable the patient and the doctor to be friends and thus permit the unencumbered sharing of personal information, start even before the history-taking is initiated [Figure 1]. These include (1) Exhibiting empathy and concern; (2) Initiating small talk as soon as the meeting starts, like asking about the patient's background, hometown and family to make him/her comfortable; (3) Neither interrupting the flow of conversation nor forcing information; (4) Reserving adequate time for the conversation to take place; (5) Not rigidly guiding the flow of facts into compartmentalized, artificially-made divisions; (6) Having a one-on-one private conversation; and, (7) Assuring and then maintaining absolute confidentiality. Unfortunately, these “seven steps” are never emphasized during the numerous classes on history-taking that one undertakes during residency.
Figure 1: (a) The kittens want to seek comfort but are afraid to do so; and (b) The spontaneity and the joy of communicating are obvious on the faces of the puppies. Every pet-owner knows that reaching out to their pets by way of both nonverbal and verbal communication prior to encouraging them to follow orders and training them, achieves a spontaneous and an unbridled response. This establishment of a feeling of mutual trust prior to the actual professional communication works wonders in the patient-doctor relationship also

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Why is the consultant able to elicit more information than a resident from the patient? Is it because he/she has learnt a better technique of history-taking over time? The answer is an emphatic “No.” It is simply because the patient, understanding that one needs to divulge the essential information about oneself solely to seek help has, in one's mind, grudgingly granted this concession to the senior doctor. Is the person actually comfortable with the personal disclosures that he/she has made? The answer is again “No.” The difference between a doctor whom most patients seek, and the one whom no one wants to revisit, is not based on the skills of the doctor but on the comfort levels that the patient feels in sharing personal information.

In the story of Ali Baba and the Forty Thieves, in Antoine Galland's translated version of the book “One Thousand and One Nights” (Les mille et une nuits), the phrase “Open sesame” miraculously enables Ali Baba to access the hidden treasure within the cave. The anxiousness and greed of his brother to obtain the same treasure made his mind freeze so that he forgot the magical phrase and lost not only the treasure but also his life. History-taking, that may be termed as a patient-doctor conversation, is a mirror reflecting the images of commonality between two people. If one is frozen, the other also appears to be so. Adhering to the “saptapadi principle” before the initiation of history-taking is akin to the phrase “open sesame” that exposes the treasure-trove of information regarding the patient's illness; these “seven steps” may also help in making the duo life-long friends.




    Figures

  [Figure 1]



 

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