Give a man a fish and you feed him for a day.
Teach a man
to fish and you feed him for a lifetime.
Welcome to the second
edition of The Patient History: An Evidence-Based Approach to
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
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.
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.
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,
Lawrence M. Tierney, Jr., MD
Gerald W. Smetana, MD