Studies have shown that 60-80% of diagnosis are made on the medical history one takes from a patient, therefore it is a very important skill to perfect.
All of these skills interweave throughout the discussion of the presenting illness:
1. Eliciting the patient's narrative about the presenting problem
- Asking Open Questions: invite the patient to "open up" by saying, "Could you tell me about this pain from the beginning?" Open questions encourage the patient to express the presenting problem in their own words and bring in all the relevant factors from the patient's POW.
- Establish Motivation: identify the reason(s) for attenting today
- Facilitation techniques: "Uh-huh," nods, and paraphrasing info encourage patient's opening up.
- Responding to patient's emotional reactions: Either reflect on the patient's feelings as you have understood them ("You have been feeling sad since that event") or legitimize their feelinds ("most people worried when they have chest pain," or "It is natural to be concerned when your baby is ill").
- Summarizing and Feedback
- Probing to Completeness: "Is there anything else concerning you?"
2. The skill to assemble the informaiton obtained from a medical (disease) perspective
A neat trick to remember the diagnostic questions one can ask:
- Where: The location and radiation of a symptom
- When: When it began, fluctuation over time, duration
- Quality: What it feels like
- Quantity: Intensity, extent, degree of disability
- Aggravating and Alleviating factors: what makes it worse/better
- Associated symptoms: other symptoms that have occurred with the main symptom
- Beleifs: the patient's beliefs about the symptoms
3. The skill to enable patients to talk about how the illness is impacting on their life circumstances.
The patient's perspective includes ideas, feelings, expectations and effects. In a patient centred approach to the medical interview it is just as important to explore this area as the Medical perspective in part 2 above.