The importance of the history in the medical clinic and the cost of unnecessary tests

Sandler, Gerald

doi:10.1016/0002-8703(80)90076-9

Cited by 164 publications

(80 citation statements)

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“…Patients still expect physicians to lay a hand or a stethoscope on them 18,19 ; skilled history, examination, and clinical reasoning contribute to accurate diagnoses 15,25 ; medical educators can play a role in decreasing diagnostic errors that arise from faulty clinical thinking, which could lead to more costeffective care. 15,18,19 Some examples of clinical skills curricula in internal medicine residencies include the Boston Medical Center curriculum, featuring scheduled bedside rounds by master clinicians, physical diagnosis workshops, and physical examination OSCE (objective-structured clinical examination) during intern orientation; the Brigham and Women's hospital curriculum, featuring workshops, faculty development on bedside teaching, master clinician rounds, and a teaching resident elective with attending observation and feedback; and the Stanford 25 curriculum, which features 25 physical diagnostic maneuvers taught by master clinicians supplemented by an online syllabus.…”

Section: Casementioning

confidence: 99%

Patient-Centered Care or Patient Data-Centered Care: A Tale of 2 Admissions

Ramani¹

2013

Journal of Graduate Medical Education

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Section: Casementioning

confidence: 99%

Patient-Centered Care or Patient Data-Centered Care: A Tale of 2 Admissions

Ramani¹

2013

Journal of Graduate Medical Education

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“…Several reports have shown that the medical history obtained during the medical interview provides 60-80% of the information needed for an accurate diagnosis (Hampton et al 1975;Sandler 1980;Kassirer 1983;Peterson 1992). Numerous medical interview behaviors can be used to gather medical information from patients, including open-ended questions (Rutter and Cox 1981;Cox et al 1981a, b;Beckman and Frankel 1984;Roter and Hall 1987;Maguire et al 1996;Marvel et al 1999;Takemura et al 2004), facilitation (Rogers 1980;Egan 1990;Wissow 1994), the open-to-closed cone (Cox et al 1981a; Bird and Cohen-Cole adjustment was made in this study to eliminate its effects.…”

confidence: 99%

Identifying Medical Interview Behaviors that Best Elicit Information from Patients in Clinical Practice

Takemura

Atsumi

Tsuda

2007

Tohoku J. Exp. Med.

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Many textbooks indicate the desirability of using specific medical interview behaviors to obtain information from patients, although little evidence has been presented. The aim of this study is to investigate the relationships between the use of medical interview behaviors and the amount of information obtained. The behaviors studied included: open-ended questions, facilitation (comments or interviewer behavior that encourages the patient to continue talking), the open-to-closed cone (the gradual narrowing of focus from an initial nondirective approach to a more direct exploration), summarization (providing the patient with an explicit verbal summary of the information gathered thus far), and surveying problems. The subjects were 315 patients who visited an outpatient facility. These medical interviews were videotaped and reviewed by a trained rater using the Takemura Medical Interview Rating Scale, which was developed to assess the use of particular medical interview behaviors and to measure the amount of information obtained from patients regarding their chief physical complaints. Significant positive relationships were found between three particular interview behaviors and the amount of information obtained: facilitation, the open-to-closed cone, and summarization. These positive relationships were still present after adjusting for other medical interview behaviors used, and after adjusting for the time duration of the medical interviews (F = 15.3, p < 0.0001; F = 40.1, p < 0.0001; F = 5.57, p = 0.019, respectedly). This study reveals a positive relationship between three specific medical interview behaviors (facilitation, the open-to-closed cone, and summarization) and the amount of information obtained in a real clinical practice setting.

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“…This information, along with the findings on physical examination, are then synthesized to form a problem list from which a differential diagnosis or diagnoses can be made. Research dating back to the 1970's suggests that patient history alone can yield a diagnosis in 76% of cases [1] and, otherwise, can contribute up to 80% of the information required to make a diagnosis [1][2][3][4][5]. More recent studies point to the additional benefits of patient rapport, better patient health literacy, therapeutic compliance, and clinical outcomes [6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Thoughtful questions in the history as new pedagogy for teaching patient centred care: A pilot study in an Australian Rural Clinical School (RCS).

Middleton¹,

Buist²

2018

J Contemp Med Edu

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Introduction:The taking of the patient medical history is at the heart of the doctor patient relationship. It is often critical for a diagnosis and also plays an important part in ongoing clinical care of the patient. However, with the move away from assessment by "long case" to the Objective Structured Clinical Examination (OSCE), medical students spend less time with patients and when they do take a history it is done in a didactic checklist manner. This learning is contrary to the needs of the now more health literate patient. Methods: By an iterative process, we developed a program of teaching medical history at the bedside of real patients that focussed on listening to what the patient said as opposed to the traditional history checklist. By anonymous online survey we sought feedback from the students on this way teaching. Results: Over the 3 years of this program (from 2013) 76 of the 85 students responded to the survey (89% response rate). Students were mostly receptive to the ideas of following up on clues and information that patients gave them and then presenting this information in a more interesting way to peers. However, there was less enthusiasm, for taking the history in a more casual but patient centred way. Conclusion: This program was feasible and welcomed by the students. The major limitations were that students were frustrated by not being taught examinable OSCE cases and that the time commitment by the clinician was onerous.

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The importance of the history in the medical clinic and the cost of unnecessary tests

Cited by 164 publications

References 1 publication

Patient-Centered Care or Patient Data-Centered Care: A Tale of 2 Admissions

Patient-Centered Care or Patient Data-Centered Care: A Tale of 2 Admissions

Identifying Medical Interview Behaviors that Best Elicit Information from Patients in Clinical Practice

Thoughtful questions in the history as new pedagogy for teaching patient centred care: A pilot study in an Australian Rural Clinical School (RCS).

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