Taking a thorough patient history (history of the present illness) is a form of art that should be learned from a true master! In this video, from our Infectious Disease Essentials course, Dr John Fisher explains his ingenious approach, using the three paragraph method, to take a patient's history. Be sure to check out our interview with Dr Fisher, too!
[00:00:00] The key to medical and surgical diagnosis is to have the same orderly approach to every patient. It is well known that 70% of diagnoses can be made by excellent history taking. Physical exam and labs make about 30% of diagnoses. When taking a history, I recommend using a "three paragraphs" approach to ensure you don't miss anything.
[00:00:30] The chief complaint or presenting complaint is the key. The first step in taking a great history is to make the patient decide what is the worst of all symptoms, and then allow a description in his or her own words without interrupting. If the patient strays from describing the chief complaint, get the patient back to it. No other symptom descriptions are allowed at this point. When the physician has a complete understanding
[00:01:00] of this chief complaint, that completes paragraph one of the history template. In paragraph two, the patient may now describe all symptoms associated with the chief complaint in their own words. The physician should now have a reasonable idea of the organ system causing the trouble. In paragraph three, the physician inquires of symptoms in the suspected organ system which the patient
[00:01:30] did not complain of. At this point, the history taking a present illness is finished. The remainder of the history can be considered with the offending organ system in mind. For infectious diseases, a travel history is very important. As the patient is describing the circumstances surrounding the chief complaint, travel history might well come up. But if it hasn't, it should be addressed at this point along with other relevant social factors such as occupation, smoking
[00:02:00] history, and sexual history. With respect to the physical exam, the exam of the offending organ system must be comprehensive, that is world-class. At least a cursory exam should be done of other systems with emphasis on certain points in some cases. Previously seen patients are evaluated in exactly the same way except that the medical record should be at least briefly reviewed before interviewing the patient.
[00:02:30] If you stick to this template with every patient, you'll compose a thorough and complete history of the present illness. This will allow you to be better equipped to make a quick and accurate diagnosis for your patient.