What You Should Know About History-taking

The history begins with your description of your symptoms. When they began and how they have changed over time. Once you’ve initially presented these symptoms, your doctor will ask you more detailed questions that can flesh out crucial details that may distinguish a number of different causes.

What makes your symptoms better? What makes them worse? If you are experiencing pain, does it start in one place and radiate to another area? What type of pain is it (squeezing, sharp, crampy, burning or achy)?

This question can be challenging for some to answer. To many, pain is just pain. If you haven’t experienced a variety of different types of pain, it might be hard to distinguish the different types. It’s not unlike being an inexperienced wine taster and not being able to distinguish such subtleties.

Language and culture also influence your description.

Pain due to gastroenteritis, periods and labour are described as crampy. Pain from the passage of kidney and gall stones is typically colicky. Angina or chest pain from narrowed coronary arteries is typically – but not always – squeezing.

With angina, discomfort may radiate into the throat and neck or to either arm. Here typical exacerbating and alleviating factors are very important. Angina typically comes on with anything that increases the work of the heart, such as exertion (exercise) and anxiety – in short, physical or emotional stress.

Are there other symptoms associated with your primary symptom?

Nausea or queasiness is commonly associated with angina. In some cases, it may be the only symptom. Patients may experience nausea with exertion and acute stress without the typical chest pain.

That’s why – to you and your doctors – history is so important.

Next: the doctor’s inquisition – why we ask questions the way we do.


About Davidicus Wong

I am a family physician. I write a weekly newspaper column, Healthwise for the Vancouver Courier, Burnaby Now, Royal City Record and Richmond News.
This entry was posted in patient-doctor relationship and tagged , . Bookmark the permalink.

3 Responses to What You Should Know About History-taking

  1. mysterycoach says:

    You know, a lot of people are affected by stress at work, like me 🙂 or sometimes interpersonal relationships which, the year before last I got sick due to stress from work. My body said… “okay, you’re done” and I got sick. It was like the 24 hour flu virus but it was stress related. I wonder how many people/doctor’s recognize that it’s “their life” giving them symptoms and not the common flu bug you know? What do you think about that?

    I know, this is hard because most deny things, say they can handle it and may not realize the effect their environments have on them but… know what I mean? That’s got to be difficult to get from a patient…

    • Talking to patients about the presentation of illness can be a journey of discovery for the patient with the doctor as a guide and travel companion. When we as patients are asked questions that open us to new personal insights, both may discover the complex origins of our problems.

      Certainly emotional stress can affect our immune system and make us more susceptible to infections. Depression can manifest itself with the physical symptoms of extreme fatigue, changes in appetite, sleep disturbances and unexplained pain.

      You have good insight, M.C.!

      • mysterycoach says:

        Thank you honey. I’ve experienced it all first hand so I have a very real clue … and the problem, I believe … is that we don’t open up and discuss these things with a physician. That is a problem…

        Many reasons for that as well. 1. People don’t recognize it think they have to be strong or what not, 2. attention (some get attention being sick) 3. denial, 4. secrecy, shame…

        Sigh… I like talking to you, you’re open to these discussions. I have had other physicians, who I’ve literally dismissed who were not as willing to have these discussions. Thank you. 🙂

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