Back to basics: The forgotten art of patient history-taking and why it’s important for accurate diagnosis

The advent of technology, busy OPDs, and more patients are taking doctors away from the time-honoured practice of history taking.

ByChetana Belagere

Published Sep 27, 2023 | 9:00 AMUpdatedSep 27, 2023 | 9:00 AM

Patient history includes present illness history, past history, family history, surgical history, and anaesthesia history. (Wikimedia Commons)

In the bustling corridors of the modern medical world, amidst the hum of advanced technology, cutting-edge treatments, and a flurry of scans, blood tests, and ECGs, a time-honoured practice is often overshadowed by the clamour for rapid solutions — the art of patient history-taking.

This age-old practice, where the doctor engages at length with the patient, lies at the heart of medical care and holds the key to truly understanding their unique needs and tailoring solutions accordingly.

It is an inquiry into the patient’s medical and surgical history, and even family medical and social history. It is how the doctor learns about allergies, and the medications the patient is taking, or may have been on.

Renowned interventional cardiologist Dr Deepak Krishnamurthy of Sakra World Hospital in Bengaluru says, “Taking a complete history is important in order to focus on what we are going to do. One cannot blindly investigate with expensive tests in all possible directions. A focused and detailed history helps us narrow down our diagnosis to a few possibilities.”

Speaking about the importance of history-taking, doctors from the Indian Medical Association – Telangana Chapter agree that amidst the rush for rapid diagnosis and treatment, the importance of a comprehensive patient history is sometimes eclipsed.

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What is patient history-taking?

Patient history-taking is not a mere checklist of symptoms — it’s a narrative, an intimate conversation.

Dr Abhay Gundgurthi, an endocrinologist at The Sagar Centre for Diabetes in Bengaluru, puts it poetically: “History taking is like a dance of stories. In this dance of stories, patients share the melodies of their lives — the highs, the lows, the twists, and the turns. It’s the story of a grandfather’s heart condition, a mother’s struggle with diabetes, or a brother’s battle with cancer.”

Representative pic of patient history taking

Patient history-taking is key to understanding the patient. (Wikimedia Commons)

“While the doctor begins, ‘Tell me about your childhood. Any family history of medical conditions?’ a narrative unfolds, snippets of a family’s medical tapestry come to light. Each piece of this mosaic holds clues, painting a picture that transcends lab results and X-rays,” Dr Gundgurthi explains to South First.

At the core of patient history-taking is the art of listening. When a healthcare provider attentively listens to a patient, a whole new dimension of understanding opens up.

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Why is patient history important?

Doctors South First spoke to say that patient history is a fundamental component in all branches of medicine, serving as the bedrock for accurate diagnosis, tailored treatment planning, and informed healthcare decisions.

It encompasses past illnesses, medications, lifestyle choices, genetic predispositions, and family medical history, offering valuable insights for risk assessment, allergy management, and medication safety.

Understanding a patient’s physical, psychological, and behavioural aspects is crucial, aiding in holistic care. Patient history also aids in tracking progress, guiding specialised care, fostering effective communication, supporting research, and upholding legal and ethical standards in healthcare, they say.

Representative pic of patient history taking

With a patient’s history, a clinician can attain 60 to 70 percent clinical diagnosis. (Wikimedia Commons)

Dr Jala Bapu Reddy, a senior physician from Telangana and a member of the IMA, says, “Through skillful history-taking, accounting for present and past illnesses, family history, drug history, and various other aspects, a clinician can attain a remarkable 60 to 70 percent clinical diagnosis. This diagnosis is the foundation upon which further investigations are based, adhering to medical protocols.”

It’s a collaborative process where the patient becomes an active participant, allowing healthcare professionals to grasp the nuances of their unique health circumstances, he adds.

Dr Burri Ranga Reddy, a member of the Public Health Committee at IMA – Telangana, emphasises, “By incorporating our sensory observations, alongside essential diagnostic techniques such as physical examination, percussion, palpation, and auscultation, we can substantially decrease the costs linked to diagnosis and treatment.”

He underscores the widely-accepted view that excessive reliance on multiple diagnostic procedures not only imposes a significant financial strain on patients but also results in delays in treatment, ultimately eroding patient trust in our diagnostic competencies.

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Which doctors need it the most?

From cardiologists to neurologists, gynaecologists to general physicians, and even mental health specialists and dermatologists stress that history-taking is important. Basically, doctors from every stream of medicine.

Speaking to South First, Dr Sudhir Kumar, Consultant Neurologist at Apollo Hospital in Hyderabad says, “History-taking is important for all specialties, but probably the most important for neurology. Most diseases can be diagnosed based on history alone. For example, migraines can be diagnosed based on patient’s symptoms alone and family history. There is no test to diagnose migraine.”

He adds, “Epilepsy, too, can be diagnosed based on symptoms, as described by an attendant. Investigations such as EEG and brain scan are done to derive further information regarding the type and underlying cause of epilepsy.”

Gynaecologist Dr Usha Naveen from Nizamabad, says, “In this Google era, history-taking is strongly recommended for every doctor. Many times, 70 percent of diagnosis will be done with just the history. In that, 30 percent is by what the patient tells us and the other 40 percent is non-verbal cues, which includes patient’s expressions, movements, body gestures, eye contact, etc.”

In the realm of mental health, the significance of history-taking is paramount. Just as in physical health, understanding a patients’ background, experiences, childhood, feelings, thoughts on certain experiences, family dynamics, social circumstances, any prior mental health treatments are all very important for treatment plans and intervention.

Dr Aditya N, a clinical psychologist from Karnataka, says, “Establishing trust and rapport with patients is crucial in mental health care. Taking the time to listen to a patient’s narrative, showing empathy, and valuing their experiences through history-taking can enhance the therapeutic relationship and improve treatment outcomes.”

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Forgotten art of history-taking

The good news is, the timeless art of patient history-taking is experiencing a reawakening. As technology continues to revolutionise healthcare, the significance of this often-overlooked practice is being underscored.

The rich tapestry of a patient’s medical journey, woven through careful history-taking, is now being seen as a crucial complement to modern diagnostic tools.

with advent of technology in healthcare time spent with patients on taking history has come down. Representative Pic only

With the advent of technology in healthcare, time spent with patients in taking history has come down. (Wikimedia Commons)

Speaking to South First, Dr Neeli Ramchander, President of the IMA in Nizamabad, recalls a time when medical education emphasised on accurate diagnosis and “Pass” or “Fail” of an MBBS, MD, and DM student depended on diagnosis of cardiac lesions only based on history-taking, basic investigations, and clinical clues.

Sadly, “this approach seems to be waning in current medical education”, says Dr K Sunil Kumar, Professor and Head of Department of Government Medical College, Nizamabad.

The advent of technology is necessary and important, however, Dr Sudhir Kumar explains that despite this, it becomes very important to take a patient’s family history.

Citing an example, he says, the third-most common cause of death and disability is stroke, which causes paralysis. “You will be surprised to note that the brain scan may be normal in the first few hours after stroke onset. Even during this period (when scans do not show evidence of stroke), based on history (and examination findings), we proceed with thrombolysis (clot-buster therapy), which can save lives and prevent disability,” Dr Sudhir Kumar explains.

Degenerative diseases, such as Alzheimer’s disease (AD) and Parkinson’s disease (PD), too, can be diagnosed based on history and examination. Brain scans are done in atypical cases and rule out conditions that can mimic AD or PD.

If a doctor looks at the MRI or CT scan report first, it is most likely that they will get confused, as several conditions may produce similar findings.

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History-taking should be stressed upon

Dr Amarappa S Nagalikar, Associate Professor from Belagavi Institute Of Medical Sciences in Karnataka, says that the advent of numerous tests has shifted the focus away from history-taking.

representative pic

Nothing can replace a well-taken history, say doctors. (Wikimedia Commons)

Yet the seasoned voices of Dr Rajendra Prasad, a pulmonologist from Telangana, and Dr Gopi Krishna Rayidi, a cardiologist from Telangana, affirm that despite technological advances, a thorough history remains an indispensable tool, directing a precise diagnosis and averting unnecessary and expensive investigations.

Echoing the same thoughts, Dr Poornima from Nizamabad says that history taking is an art. “We were taught to start from present illness history, past history, family history, past surgical history, and anaesthesia history, blood-related illness like sickle cell anaemia, congenital thrombocytopenia, etc. Though we are in a tech era, our gurus are Hutchinson’s, Das, Harrison’s, Davidson’s, etc. Nothing can replace a well-taken history,” she affirms.

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More patients, less time

Today, doctors often find themselves pressed for time and the comprehensive task of taking a patient’s history, they say, can indeed feel burdensome.

The demanding schedules and heavy workload can lead to a perception of history-taking as a time-intensive endeavour.

While doctors agree that communication plays an important role beyond helping in establishing a diagnosis, busy OPDs with more number of patients have doctors bound for time. They say that there is very little time to focus on the history of the patient.

However, amidst these challenges, medical professionals vehemently assert the indispensability of this art. Dr Deepak Krishnamurthy says, “Busy OPDs and seeing more patients means less time spent with each patient and more focus on tests. That is what differentiates a good doctor from others. A good doctor should spend reasonable time in history-taking and examination of a patient.”