The Medical Inquisition: The Downsides of Traditional History-Taking

Medical students are taught to take a careful history because in most cases, therein lies the patient’s diagnosis.

When I was in medical school, we were taught how to “take a history.” This included: the history of the present illness (the presenting problem, when it began and the details of the patient’s symptoms), the review of systems (an inquiry into all the major organ systems), the patient’s past medical history (including allergies, operations and significant illnesses and hospitalizations) and family medical history.

As students, we tended to focus on getting specific details from the patient, and this often resulted in what must seem like a barrage of questions. These are intended to rule in or rule out particular medical conditions.

Particular conditions often follow a predictable pattern of presentation. For example, the pain of gallstones is often described as crampy right upper abdominal pain radiating into the back following a heavy or fatty meal.

The classical symptoms of very high blood sugars from uncontrolled diabetes are excessive thirst, hunger, urination and weight loss.

Sometimes, in the search for the diagnosis, we could get caught up in the questions and try to fit the patient into a recognizable pattern.

Physicians trained in this way, may fall into a pattern of asking many close-ended questions. The problem with this is that we limit the information we get in response, and some of the missed information may be crucial to the correct diagnosis.

Next: The good news about how medical school has improved how doctors are trained to interview.


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.
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