Why does patient
history matter?
Using patient
history is critical for an efficient and accurate diagnosis. The diagnostic
process often involves taking medical history, performing a physical
examination, prescribing diagnostic tests and interpreting the collective
results. If a piece of patient history is missing, it may misguide the entire diagnostic
pathway. Therefore, the information elucidated while taking patient history
will ultimately enable the clinician to select the timeliest approach.
Obtaining a
thorough patient history is also the first step to assure that the process is cost-effective.
By being specific and selective, the amount of unnecessary tests can be
significantly reduced. This can protect patients from extensive additional
testing that may eventually provide a diagnosis, but at a greater cost to the
patient.
Additionally, as
there has been an increase in patient volume, face-to-face time with a doctor
has become shorter, thus putting pressure on doctors to produce a timely,
accurate diagnosis. By centering the diagnostic pathway on patient-generated
information, doctors can determine health problems much more effectively.
Taking patient
history
While patient
history plays an evident role in obtaining the correct diagnosis, just how
important is it? Various studies have shown that around 70-90% of diagnoses can
be determined solely by a patient’s medical history. This indicates that
diligently interpreting a patient’s history may be the most important step of
the entire diagnostic process.
A thorough patient
history can help guide physicians to clues of what to look for. As the body and
its systems are interconnected, certain diseases tend to be linked or
associated to another condition. For instance, if a patient was given a certain
chemotherapy drug in the past but has not shared this, a late effect of that
drug may in fact be the cause of a condition. This knowledge is essential for
identifying a start point on the diagnostic pathway.
Impact on patient
experience
Reliable history
taking is particularly important for obtaining accurate information to produce
a correct diagnosis. Though it is taught, it is not an easy skill to learn as
it involves open-ended questions and active listening. If listened to, most
patients will eventually identify what is wrong. However, due to a recent
study, 75% of physicians interrupt their patient within the first 20 seconds of
explaining their symptoms. After the interruption, patients felt that they did
not provide complete information and felt disillusioned, as the physician did
not understand the full purpose of the visit. Patients also tend to have
multiple concerns when attending an appointment and it has been found that
often the most important concern is not mentioned first. If a patient is
interrupted, it is unlikely that their main concern will be confronted.
In conclusion,
obtaining a thorough, comprehensive patient history can lead to a more
cost-effective and timely diagnostic pathway. If this step is not done
correctly, the patient in the end may experience stress, both financial and emotional,
due to unnecessary testing. However, if all physicians take this step
seriously, the patient experience and benefits from early diagnosis have
potential to improve significantly.
References
Beckham HB. (1984). The effect of physician
behaviour on the collection of data. Ann
Intern Med.
Castrejon I et al. (2012). Importance of
patient history and physical examination in
rheumatoid arthritis compared to other
chronic diseases: Results of a physician survey. Arthritis Care & Research.
Muhrer, JC (2014). The importance of the
history and physical in diagnosis. The
Nurse Practitioner.
Tsukamoto T et al. (2012). The contribution
of the medical history for the diagnosis of simulated cases by medical
students. International Journal of Medical
Education.
