Dr Kathryn Fox is an Australian medical doctor and bestselling crime writer, best known for her forensic thrillers featuring pathologist Dr Anya Crichton. Drawing on her medical expertise, she crafts gripping, authentic crime fiction and is also a passionate advocate for forensic medicine education and public engagement. Her columns appear every Monday and Thursday.

Have you ever wondered why doctors are so nosy? Asking about sexual partners, infidelities, the state of your relationships? Some patients are more than happy to discuss every encounter, and sometimes even overshare, while others resent what they see as intrusion of their privacy.

A routine question, “What were you doing when the headache suddenly came on?” helps to differentiate the urgency of investigating what could be a simple tension headache from a potentially life-threatening bleed inside the brain. A shy, gentle man with no previous history of headaches responded matter-of-factly, “You know the feeling when you’re having sex in an S and M club, and your leather mask cuts off your air supply? You know, THAT feeling?”

This was more information than I was expecting, I silently wondered if I’d given the impression that I did in fact know THAT feeling.

Next time I had to ask about a sudden onset headache, this patient dropped to the floor with his girlfriend. Before I could stop them, they were simulating a sex act. For patients in these situations, it’s perfectly ok to answer, “Having sex,” and then be guided by the next question.

Then you have the patients who can’t answer a simple question without telling you every single thing and conversation that led up to a symptom. What time they woke up, what they had for breakfast … as if every second contained a vital clue. I get it, they’re trying to piece it together themselves, but time is of the essence.

Doctors ask open-ended questions, and for good reason, but sometimes a question just warrants a yes or no answer. Like, “are you experiencing the pain right now?” Pain is notoriously difficult to explain, and people use different words to describe it – dull ache, sharp, stabbing, discomfort, heaviness, burning, and the doctor is listening for key clues in the context of the patient.

Then there is the other patient, who every doctor seems to have met. Arms-crossed, eye rolling, who makes it very clear that your questions are irritating.

These patients don’t want conversation, just a quick fix despite us not being mind-readers.

Once in Emergency, an elderly patient brought in by ambulance was struggling to breathe. As the senior doctor on that night, I needed to assess him quickly and determine the cause. He refused to answer any questions.

“You must be an idiot,” he gasped. “Vets do it without asking questions.”

I briefly considered pointing out that vets sometimes use elbow-length gloves to perform internal examinations but decided it wasn’t the moment.

Symptoms mean nothing on their own. They only make sense when placed against what’s normal for you.

Presenting with shortness of breath getting out of bed could mean a number of things. If you normally walk five kilometres before breakfast, this is clearly a medical emergency and suggests a dramatic event’s occurring. If you’ve been breathless showering for years, it’s more likely an exacerbation of a chronic condition with the goal of treatment getting you back to the best you can be.

Same symptom. Completely different implications.

This is why we ask about fitness, work, daily activity and living arrangements. We’re trying to work out what’s changed for you.

Medical and family history serve the same purpose. A headache is one thing in a healthy twenty-year-old and something else entirely in someone with a history of cancer. Chest pain carries different weight depending on your risk factors. These aren’t academic distinctions. They guide decisions that matter.
Social history is where things often get tense.

Patients worry we’re judging them. That we’re prying. That we’re about to lecture them on lifestyle choices. In reality they’re practical questions.

Will you be okay to go home if you live alone?

Is there someone who can help you recover?

Will this treatment actually work in the context of your life?

Tests are seductive. They feel objective. Reassuring. Scientific. But even the best test result needs interpretation, and interpretation depends on story.

In Emergency departments especially, patients often want action now. History is the start. Often, it’s the most important part.

One of the founders of modern medicine, Sir William Osler, believed that “The good physician treats the disease; the great physician treats the patient who has the disease.”

When you’re frightened, unwell or in pain, answering questions can feel exhausting. But those questions are how we distinguish the urgent from the chronic, the dangerous from the distressing, the problem that needs fixing now from the one that needs careful follow-up.

Elbow length gloves aside, vets don’t ask questions because their patients cannot answer them. Doctors ask questions because you can.