Taking the Clinical History

In the olden days of medicine, like in the early 1900’s, the art of the medical history was practiced with pride and empathy for the patient. Physicians built their private practice and their reputations based upon their bedside manner, including their ability to listen to and understand their patients.  It use to be that 90% of the diagnosis came from the medical history, and 10% of the diagnosis was gained from a thorough, hands-on examination.

No longer.

Unfortunately, the medical history is now a lost art.  Doctors are substituting lab results for medical history and radiographic reports for the exam.  A summary of the records in our digital age has allowed doctors to cut short the questions for the patients.

Doctors are now starting to re-discover the importance of getting a complete narrative from their patients.  This leads to greater satisfaction of the patients, and a better relationship between doctor and patient.  The author William DeMyer (above) already has some excellent text books, including one of my favorite neurology texts, but now has a well-written book for doctors on the clinical history.

One of things patients can do to make their experience better at the doctor’s office is to get themselves organized with their medical story. Learn how to describe your pain that you experience.  Is it deep pain or superficial pain?  Is it one area of the back, or does it radiate to the back of the thigh, leg, or foot?  Is it worse in the morning, or at night?  What does it feel like? Burning pain? Dull ache?  Does it feel like an ice-pick is stuck in your rib cage?  How long have you had it, and is it getting worse?

Hopefully you can find a doctor who will listen to you.  Hopefully, if you end up talking to a nurse practitioner or physician’s assistant, that there is good communication in the office. The AMA has recognized the importance of the medical history:

To alter this approach, those who work on patient-physician communication are teaching and writing journal articles on “narrative medicine” and strategies to allow patients to tell their stories without being interrupted. Anecdotal evidence suggests a growing number of medical schools are adopting this tactic with the goal of making the clinical interview more patient-centered.

In our chiropractic office in Sonoma, we make it a point to sit down with new patients and let them tell us their story.  We want to understand what you are going through, and what your goals are for getting better.  We take in a lot of information from you about how your back feels, and from this information, we can better guide the physical examination or outside referrals. It’s very important to us because it is very important for you.

Todd Lloyd, DC
Chiropractor in Santa Rosa, CA

From the American Medical Association