Principles Of The Patient Interview
Difficult to LearnTechniques Continually SharpenedYears of Clinical ExperienceConsideration From a Primarily Chiropractic/neurological Viewpoint
Use Of History Questionnaires
Practice Management Groups Recommend
May Be Good for the Student Doctor
Overlooks Specific Questions Parkinson's
Difficulty Getting in and Out of Chairs Making Rapid Turns Cutting Food Changes in Handwriting
Conversely, Forms May Also Cause the Doctor to Waste Time and Even Diminish the Patient's Confidence by Leading the Doctor to Ask Useless and Even Stupid Questions
The Consummate History Elicitor Must Makethe Patient Completely Comfortable
Impotence
Bladder Incontinence
Fit Into the Patient's Preconception of How a Doctor Should Look and Behave.
Clean, Pressed, White Clinic Jacket and a Tie
A Gold Ring Through the Nose
A Good HistoryAtmosphere Is Unhurried
Patient Allowed Sufficient Time to Answer All of the Questions Completely
"The Patient Interrogation.”
Do Not Allow Rambling Endlessly About Useless Details
Doctor's Social Skills
Initial Meeting
Biographical Data - Office Questionnaire
Full Name, Date of Birth, Sex, Race, Occupation,Marital Status, Home Address, and Social SecurityNumber Should Be Recorded
Much Information May Be Gleaned by Observation of the Posture of the Patient
Antalgia
Supporting Weight With Upper Extremities
Sitting on the Edge of the Chair
Leaning Backward (Tripod)
Sitting Cross-legged
Observation of Patient Behavior and Shakingthe Patient's Hand May Yield Invaluable In-Formation Regarding Personality, Central and Peripheral Motor Function, Coordination, and Autonomic Function.
A Firm Handshake Is Associated With Confidence and Personability; A Weak or Flaccid Handshake May Indicate Introversion, or Motor Impairment. Inaccuracy Reaching to the Doctor's Hand May Indicate Dysmetria and Be a Sign of Cerebellar Dysfunction.
A Cold, Blue, and Clammy Hand May Indicate Increased Sympathetic Tone, Whereas a Hot, Flushed, and Dry Hand Might Indicate Sympathetic Paralysis. Adductionof the Thumb Into the Palm May Be an Early Sign of Upper Motor Neuron Involvement or a Late Sign of Extrapyramidal Disease.
Radial Nerve Damage Causes Weakness of the Wrist Extensors. Ulnar Nerve Involvement May Cause a Loss of Hypo-thenar and Intrinsic Hand Muscle Mass, Later, a Flexion Contracture of the 4 and 5 Digits, Which May Result in the "Claw Hand” Deformity.
A Contracture in the Palm Causing Flexion of One or More Fingers May Be a Sign of Dupuytren's Contracture, and Pain in the Area of the Radial Styloid That Is Exaggerated by Volar Flexion Might Indicate De Quervain"s Disease(Stenosing Tenosynovitis of the Abductor Longusand Extensor Brevis).
Patient HistoryPatient Sequestered 16-year-old Female With Headaches Mother or Father Oral Contraceptives Malingerer May Require Coaching
Friend or Relative in the Room May Be Extremely Useful or Absolutely Essential. A Patient With Impaired Communicative Skills or a Very Young Child Is an Example.
A Parent or Spouse May Be Quite Put off by an Office Policy That Completely Excludes His or Her Presence. I Recommend That Interested Friends and Family Be Allowed, Not Invited, Into the History-taking Area but Asked to Wait Outside During the Formal Examination. This Affords the Doctor Ample Opportunity to Add a Private History Session With the
Patient.
Subsequent to the Exam, or During a Report of the Findings Procedure, Any Person Who May Be Able to Contribute to the History's Accuracy Should Be Invited Into the Room.
A Good Patient History
Answer the Who, What, When, Where, and How ofan Illness Who Is This Person? What Exactly Is His or Her Complaint? When Did It First Occur? Where Exactly Is It Located? How Did It Occur?
Specific Areas
Chief Complaint
Present Illness
Past History
Family History
Occupational History
Review of Systems
Chief Complaint
First Sentence of History - Why
Include All Patient's Complaints
Simple and Brief
Always in the Patient's Own Words
The Chief Complaint Is Nothing More Than a List of Related Symptoms Experienced by the Patient Prior to Seeing a Doctor. Failure to Actually Understand a Patient's Complaints Can and Does Often Lead to Many an Erroneous Diagnosis.
History of Present Illness
Single Most Important Portion of a New Patient Work-upEssential Factual Recreation of Events Leading up to Patient's PresentationChronological Sequencing Date and Mode of Onset Location and Character Course and Duration Exacerbate or Alleviate Relation to Other Body Systems
Specific Location
Patient Actually Attempt to Point With One Finger to the Exact Location of the Complaint Radicular Versus Plexus Versus Peripheral Nerve Distributions
Pain in Scleratome Distribution Is "Achey," Deep, and Poorly Localized.
When the Pain Begins in One Location and Radiates to Another, As Is Commonly Encountered in Spinal Complaints, It Is Useful to Have the Patient Actually Point Out the Entire Pathway.
Date and Mode of Onset
Date of Onset Calendar Date Important in Determining the System Involved
Ultimate Diagnosis - Sternal Pain Experienced During Exertion Is More Indicative of Cardiac Disease Than Is Sternal Pain Associated With a Punch in the Chest!
Character"Dizziness”?Pain Should Be Graded and DescribedExact Nature of the Symptoms“Numbness”? Temporal (Time) Profile Progressive Intermittent or Relapsing Acute Onset Followed by Gradual Recovery
Course, Duration, and Effects of Treatment
Improvement or Worsening of a Condition Clearer Understanding of the Entire Situation ofthe Particular Patient
Details of Factors That Alter the Course of the Disease Better After a Night's Sleep? Does Lifting at Work Exacerbate? Does Aspirin or Hot Baths Relieve?
Request Records
Not to Replace Your DiagnosisAvoid Repeating Unnecessary TestsSee If the Patient Has Reported a Similar History in the PastNever Assume a Previous Diagnosis Is Correct
Relationship to Other Symptoms
Patients Are Allowed to Suffer From More ThanOne Illness
Seemingly Unrelated Symptoms Might Dramatically Change the Diagnostic or Therapeutic Options Available Radiation of Pain Lower Extremity Bowel or Bladder Symptoms.
Pre-existing Illness
May Have Direct Bearing Patient May Not See the Relationship
Carpal Tunnel Syndrome Secondary to Hypothyroidism
Back Pain Associated With Genitourinary Disease
Headache Secondary to Hypertension
Past History
Dates and Descriptions of Prior Major Illnesses or HospitalizationsRecent Visits to PhysiciansCurrent Medications or Known AllergiesExercise and Personal HygieneTobacco, Alcohol, or Street Drugs? If So, How Much?
Occupational History
Often OverlookedMay Be Directly or Indirectly Related to the Presenting Complaint Wrist Pain in the Factory Pieceworker or Typist
Chronic Headaches in the Interior Room Painter or High-powered Executive
Uncover Job Specifics
"Warehouse Worker” May Be Lifting Heavy Objects May Be Driving a Forklift
Helps Determine the Cause of the Complaint
Impose Intelligent Job Restrictions
Review of SystemsMay Well Reveal a Symptom or Disease That the Patient Has Omitted From the HistoryApparently Unrelated Symptoms Have a Common Cause Weight Gain May Be Related to Carpal Tunnel Syndrome Hypothyroidism
Back Pain and Incontinence Visual Complaints and Numbness
Areas to ReviewBody WeightSkin and Skin AppendagesEyes, Ears, Nose, and ThroatCardiorespiratory SystemGastrointestinal SystemGenitourinary SystemReproductive System (Including Menstrual and Obstetrical History)Psychiatric State
Do Not Put Words in the Patient's Mouth. The Patient Should Tell the Story, Withthe Doctor Serving As a Guide
There Is No Shortcut to the Development of a Good History. It Is a Painstaking Process That, When Properly Performed, Will Usually Reduce the Diagnostic Possibilities From a List of Dozens to a List of but One or Two.
Recording The Patient History
It Is Most Beneficial for the Doctor to Learn or Invent a System of Shorthand So That the History Can Be Recorded As It Is Delivered by the Patient
This Enables a Detailed Account to Be Given in theRecord, or to Be Dictated for Transcription at a Later Date
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