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written by Prof Dr Omar Hasan Kasule Sr.
Observations before history taking
·
Smile, furtive,
anxious, frightened, depressed?
·
Eye contact?
·
Obvious signs:
Parkinson disease, stroke, severe anemia, jaundice
Types of questions
·
Start with an
open question (indirect)?
·
Direct or
closed questions come later
·
Patient-centered
interview focuses first on what the patients perceives as the main problems
(illness framework)
·
Disease-centered
interview focuses on pathology as perceived by the physician (disease
framework).
Tips
on history taking
·
Beware patients
respect doctors and may agree to suggested answers
·
Be careful in
asking for PMH so that the patient does not think you ignore the presenting
complaints
·
Encourage the patient
to speak without interruption
·
Converse and do
not interrogate
·
Information out
of context may be revealing
Common words may have a different meaning to the patient:
·
Diarrhea and
constipation
·
Wind
·
Indigestion
·
Blackout
·
Dizziness
·
Pins and
needles
·
Pash
Medical terms misunderstood by the patient
·
Arthritis
·
Migraine
·
Stroke
·
Palpitation
·
Anemia
·
Heart attack
Assessing the impact of symptoms
·
Ask about
exercise tolerance: walk, climb stairs, house work, ADL,
·
Effect on work
·
Effect on
sports and recreation
·
Effect on
eating
·
Effect on
social life
Types of patients
Garrulous = talks too much without giving useful information
Well informed patient
Angry patient
History from accompanying persons