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Give a man a fish and you feed him for a day.
Teach a man to fish and you feed him for a lifetime.

—Chinese Proverb

Welcome to the second edition of The Patient History: An Evidence-Based Approach to Differential Diagnosis. The purpose of this book is to introduce aspiring healthcare professionals to the timeless art of history taking, the gateway to establishing a diagnosis for a patient's symptoms. The patient's unique story lies at the heart of this endeavor and defies the categorization inherent to the printed page. There are, however, fundamental principles that can, and should, be articulated to start the novice on the correct path.

What makes this book different from other books on primary care? First and foremost, we use a patient-centered approach and have organized the book by symptoms rather than by diseases. Symptoms, after all, bring patients to the clinician. Second, we apply principles of evidence-based medicine to the clinical history; we highlight from the medical literature the most fruitful lines of questioning for making a diagnosis.

Despite the proliferation of modern diagnostic and imaging techniques, there is recent evidence that clinicians can still make a diagnosis for most patients using the history alone (Paley et al. Arch Intern Med. 2011;171:1394–1396). In this book, authors describe how historical data help to confirm or refute a particular diagnosis. Where aspects of the history have not been formally studied, the epidemiology, prevalence, and prognosis of the most common underlying conditions are reviewed. Such information, integrated with clinical experience, helps guide the interviewer toward the most important diagnostic considerations for a given symptom.

The book's introductory chapters cover general principles of history taking and the evidence-based method. The remaining symptom-based chapters tackle 59 common clinical symptoms, including the following elements: clinical case scenario, background and key terminology, differential diagnosis, interview framework and tips, alarm symptoms (features that alert the clinician to the most serious diagnoses), focused questions (with respective likelihood ratios), prognosis, caveats or clinical pearls, and references. Each chapter concludes with a Diagnostic Approach section that includes color algorithms and several multiple-choice questions to test your knowledge of the material. We conclude the book with a chapter on how to communicate the history to colleagues or consultants.

In each chapter, we include multiple actual questions for practical usage, ranging from basic queries to those that an experienced clinician might employ. We have not covered the physical examination or laboratory evaluation, lest we detract from the focus of the book—history taking.

Learning the clinical history requires communication, clinical experience with patients, and observation of master historians. Faith Fitzgerald and Larry Tierney, two such masters, open and close the book covering critical but often ignored aspects of this ancient art. We hope that this book gives you the fishing gear, or tools, for a successful journey to clinical excellence.

Mark C. Henderson, MD
Sacramento, California
Lawrence M. Tierney, Jr., MD
San Francisco, California
Gerald W. Smetana, MD
Boston, Massachusetts

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