Monday, 4 December 2017
Whether you are a medical student or a practicing physician, it's always a challenge when you face a patient coming with few symptoms (in non-emergency setting), and seeking for your help.
It's almost fruitless to skip history taking towards lab investigations or imaging.
The following are history taking tips that if you follow, you are likely to explore your patient's symptoms very efficiently, and makes your life easier:
1- Make sure you, and your patient are in comfort (both physical and psychological). You both should have enough time to talk, and listen to each other, in a calm office.
2- You should make a short introduction, in such a way that you win the patient's trust. All barriers should be removed, so the patient feels free to tell you everything. This can be by asking about his/her job, shortly discussing the media news, finance, cultural events, daily life, ..etc. You should be so friendly.
3- At the beginning let the patient talk freely, without much interruption. Ask open questions and stay listening. An example of open questions, is "Can you tell me about your problem?". Let him/her say everything he/she likes to tell. Only interrupt when the patient's words deviate from the main focus of the interview, to bring back the direction of the conversation in the medical history taking general path.
4- When it seems that the patient has nothing more to add, start changing your questions to closed questions. An example of closed questions, is "how many times you vomited yesterday?".
The aim of closed questions is to close the gaps in the history.
Remember that when the patient tells the story, it won't be perfect. There must be many holes that to be sealed. When you can identify these holes, you can seal them with very specific and targeted closed questions.
5- When a patients tells you something that cannot be easily believable, you should confirm by further asking, probably again and again. You have always confirm what the patient mean, especially if the answer is a critical piece of information.
6- During history taking, make the habit of ongoing symptom analysis. I mean by analysis here, is to translate symptoms into "pathology or sometimes a diagnosis". For example, productive cough, breathlessness, and pleuritic chest pain can be "translated" into lobar pneumonia.
This requires training and adequate basic knowledge of the differential diagnosis of each symptom alone and in combination with other symptoms.
7- By the end of your history taking you should have now analyzed the clinical data enough to make a list of reasonable differential diagnoses. This list should start with the most likely, and ends with the least likely diagnosis. In this way, you are now comfortable enough to proceed towards the diagnostic steps, and you are almost certainly near to make a definitive diagnosis.