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History of Present Illness

  • James BinderEmail author
Chapter
Part of the Current Clinical Practice book series (CCP)

Abstract

Eighteen seconds. Maybe 23 s. That’s all the time an average patient has to tell his story before he is interrupted. Seventy percent of patients never get to finish their story [1, 2]. Why? The obvious answer: physicians feel rushed for time. However, that does not explain the 18 s fully. Why not interrupt after 2 s? I think the 18 s is a cursory attempt to listen to the patient before moving to the real task of the interview: gather symptom data needed for diagnosis. It is a false dichotomy. During the opening phase, the clinician listens to the patient and begins to gather psychosocial and biological data needed for accurate diagnosis (see Chap. 2). This takes 3-5 min to accomplish, not 18 s. The clinician listens to the patient and gathers data during the second phase of the interview as well. Only, the emphasis shifts to gathering the data that the patient does not spontaneously offer and that the clinician needs for accurate diagnosis.

Keywords

Chest Pain Sore Throat Present Illness Strong Engagement Person Technique 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Beckman HB, Frankel RM (1984) The effect of physician behavior on the collection of data. Ann Intern Med 101:692-696PubMedCrossRefGoogle Scholar
  2. 2.
    Marvel MK, Epstein RM, Flowers K, Beckman HB (1999) Soliciting the patient’ agenda: have we improved? JAMA 281:283-287PubMedCrossRefGoogle Scholar
  3. 3.
    Osler W (1904) The master-word in medicine. In: Aequanimites with other addresses to medical students, nurses, and practitioners of medicine. Blakiston, Philadelphia, PAGoogle Scholar
  4. 4.
    Graber ML, Franklin N, Gordon R (2005) Diagnostic errors in internal medicine. Arch Intern Med 165:1493-1499PubMedCrossRefGoogle Scholar
  5. 5.
    Morgan WL, Engel GL (1969) The clinical approach to the patient. WB Saunders, Philadelphia, PAGoogle Scholar
  6. 6.
    Kliegman RM (2004) Acute and chronic abdominal pain. In: Kliegman RM, Greenbaum LA, Lye PS (eds) Practical strategies in pediatric diagnosis and therapy, 2nd edn. Elsevior Saunders, Philadelphia, PAGoogle Scholar
  7. 7.
    Smith RC (2002) Patient-centered interviewing: an evidence-based method, 2nd edn. Lippincott Williams and Wilkens, Philadelphia, PAGoogle Scholar
  8. 8.
    Coulehan JC, Block MR (2006) The medical interview in mastering skills for clinical practice, 5th edn. F.A. Davis, Philadelphia, PAGoogle Scholar
  9. 9.
    Sackett DL, Haynes RB, Guyatt GN, Tugwell P (1991) Clinical epidemiology: a basic science for clinical medicine, 2nd edn. Little, Brown, Boston, MAGoogle Scholar
  10. 10.
    Barrows HS, Norman GR, Neufield VR, Feightner JW (1982) The clinical reasoning of randomly selected physicians in general medical practice. Clin Invest Med 5:49-55PubMedGoogle Scholar
  11. 11.
    Kuhn GJ (2002) Diagnostic errors. Acad Emerg Med 9:740-750PubMedCrossRefGoogle Scholar
  12. 12.
    Platt FW, Gordon GH (2004) Field guide to the difficult interview, 2nd edn. Lippincott Williams and Wilkins, Philadelphia, PAGoogle Scholar
  13. 13.
    Roter DL, Hall JA (2006) Doctors talking with patients/patients talking with doctors: improving communication in medical visits, 2nd edn. Praeger, Westport, CTGoogle Scholar
  14. 14.
    University of Pittsburgh-Teaching Times (2006) November, vol XIIGoogle Scholar
  15. 15.
    Chungs SS, Gerber P, Kirlin KA (2006) Ictal eye closure is a reliable indicator for psychogenic nonepileptic seizures. Neurology 66:1730-1731CrossRefGoogle Scholar
  16. 16.
    Davis G, Henderson MC, Smetana GW (2005) The evidence-based approach to clinical decision making. In: Tierny LM, Henderson MC (eds) The patient history: evidence-based approach. Large Medical Book/McGraw Hill, New YorkGoogle Scholar
  17. 17.
    Sylvester FA, Hyams JS (2004) Gastrointestinal bleeding. In: Kliegman RM, Greenbaum LA, Lye PS (eds) Practical strategies in pediatric diagnosis and therapy, 2nd edn. Elsevier Saunders, Philadelphia, PAGoogle Scholar
  18. 18.
    Becker T, Kharhanda A, Bucher R (2007) Atypical clinical features of pediatric appendicitis. Acad Emerg Med 14:124-129PubMedCrossRefGoogle Scholar
  19. 19.
    Platt FW, McMath JC (1979) Clinical hypocompetence: the interview. Ann Intern Med 91:898-902PubMedCrossRefGoogle Scholar
  20. 20.
    Shea SC (1998) Psychiatric interviewing: the art of understanding: a practical guide for psychiatrists, psychologists, nurses, and other mental health pprofessionals, 2nd edn. WB Saunders, Philadelphia, PAGoogle Scholar
  21. 21.
    Korsch BM, Aley EF (1973) Pediatric interviewing techniques: current pediatric therapy. Sci Am 3:1-42Google Scholar
  22. 22.
    Mishler EG (1984) The discourse of medicine: dialectics of medical interviews. Ablex, Norwood, NJGoogle Scholar
  23. 23.
    Gould RK, Rothenberg MB (1973) The chronically ill child facing death: how can the pediatrician help. Clin Pediatr 12:447-449CrossRefGoogle Scholar

Copyright information

© Humana Press, a part of Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Marshall University School of MedicineHuntingtonUSA

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