MEDICAL INTERVIEW: HOW TO ELICIT ALL OF THE PATIENTS SYMPTOMS

Studies show that patients omit symptoms when explaining their history to the doctor. I see this in academics when I get a story that adds information compared to what the resident elicited. When I observe resident history taking directly, I sometimes can gain insight into optimal and suboptimal medical history taking.

Interruptions can be well-intentioned, but studies show they may prevent the patient from giving all the symptoms. Patients get off track and never finish. I recommend starting with a request for the whole story, or some such variant, and then listening without interruption. Facilitative questions are okay, like “tell me more” or “tell me more about the onset.” I usually don’t ask those until they are done talking.

At the end, I like to ask “what else?” Some patients, no doubt used to the medical system and perhaps also out of politeness, give very brief presentations. I want them to know they have permission to give more information.

A full account of symptoms in some cases is the most important factor in making the diagnosis. Patients often leave out key information, so taking a full and open history without interruption is key to medical diagnosis.

Take home points:
Start the medical history with an open invitation
Do not interrupt
Use facilitative questions to get more information “tell me more about…”
At the end ask “what else?”

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