Good history-taking skills by doctors crucial in effective patient diagnoses

Good history-taking skills by doctors crucial in effective patient diagnoses
"Good history-taking skills by doctors crucial in effective patient diagnoses"

“I shall do by my patients as I would be done by; shall obtain consultation whenever I, or they desire; shall include them to the extent they wish in all important decisions; and shall minimise suffering whenever a cure cannot be obtained, understanding that a dignified death is an important goal in everyone’s life.” – The Hippocratic Oath.

To abide by the Hippocratic Oath, one should be well-versed in the art of taking medical history. Obtaining a true, representative account of what is troubling a patient and how it has evolved over time isn’t easy. It requires patience, practice, understanding, and concentration.

History-taking is simply a sharing of experience between patient and doctor. In general, a medical history includes an inquiry into the patient’s chief complaint, history of medical, past surgical, family medical, social habits, allergies, and current, or recently stopped medications.

In medical school, our professors kept us on our toes with their critical reviews during our case presentations. I can still feel the verbal whiplash of their criticisms. As mentally and psychologically painful they were at that time, such comments served to hone our skills and develop our critical/lateral thinking.

Our professors’ dictum was “With good history-taking, 80 per cent of the treatment is taken care of, with investigation, medical, and surgical intervention being the remainder.”

Such intense training helped me in my patient care over the years.

Earlier this week, I had a patient who walked into my clinic, seeking help. I first met him 16 months ago for a regular eye assessment.

As usual, my initial history-taking was extensive. This time, he came in for bleeding over the outer part of his left eye over the past two days. This was his second episode in three months.

There were no obvious or significant factors that suggested any link to the problem. Looking back at my initial notes, I noted that he had a heart bypass surgery in August 2022.

Now, 20 months post-cardiac surgery, he was surprisingly still on double blood thinners. The normal practice was to stop one thinner after 12 months. Suspecting that that was causing the eye bleeding, I explained and advised for a cardiology opinion. The cardiologist, after assessment, concurred with my opinion and stopped one blood thinner.

My Sherlock Holmes deductions played out. From the patient’s point of view, it was of some comfort to have a probable cause for his eye bleeding. What was more important was being able to reduce his daily medication intake by one medicine. That made him happier.

I must thank my medical college professors for being such hard task masters.

As once said by Hazrat Imam Ali: “Eyesight is useless if the insight is blind”.

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