Friday, June 3, 2016

Importance of Patient History for Diagnosis

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.


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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.