THE PAST MEDICAL HISTORY

August 29 th , 2005 John Gazewood, MD, MSPH

Practice of Medicine-1

Goals

Objectives

At the conclusion of this lecture, you should be able to:

  1. Describe the content of the "other active problems" portion of a patient's history.
  2. Describe the content and structure of the past medical history.
  3. Describe how to use communication techniques in obtaining the past medical history.
  4. Know that some portions of the past medical history are obtained in the history of present illness.

Content of the Medical Interview

The majority of the information needed to diagnose and manage a patient's problem(s) is obtained during the history of present illness. The information obtained during the latter portions of the interview provides a complete database of the patient's medical, personal and family history needed to provide optimal management of a patient's problems. Frequently, information contained in the past history is asked about and reported in the history of present illness. For example, in interviewing a patient with chest pain that is suspicious for angina, a physician would query the patient about health habits (for example smoking), past history (hypertension, diabetes, hyperlipidemia), and family history (of early coronary artery disease) that would affect the patient's probability of having coronary artery disease.

Other Active Problems

Sample questions:

Past Medical History

Contents

Specific points relevant to each content item

Family History

Systematic inquiry into possible presence of disease states in the family that might affect patient's health. This would include information about:

Patient Profile (Social History)

Details and knowledge of the patient - their work, relationships, hobbies, beliefs- often develop over time - the days of a hospital stay or the years of a relationship in the office. In the short term, need to answer three questions: How does the patient's lifestyle or personal traits:

Content:

Review of Systems (ROS)

The ROS

Obviously, you could spend a lot of time memorizing these questions, and torturing patients with them when you interview them. Please don't! Remember, if you are spending a lot of time in the review of systems, you probably are not interviewing effectively! Use open-ended, broad introductory questions, with follow-up as needed!

Putting it together

One author's suggestion for time allotment:

References

Coulehan and Block, The Medical Interview: Mastering Skills for Clinical Practice, 4 th ed.

Cohen-Cole, The Medical Interview: The Three-function Approach.

Mosby's Guide to the Physical Examination.

Verdon, ME, Siemens, K. Yield of review of systems in a self-administered questionnaire. J Am Board Fam Prac 1997;10:20-27.

Platt, FW, McMath, JC. Clinical hypocompetence: the interview. Ann Intern Med 1979; 91:898-902