Taking the history

The aim of doctors is to understand the patient and the disease. Taking the history is key to both of these objectives. Only through talking to patients can doctors can get to know them as people, and their personal experience of illness, and the history remains the richest source of information about their diseases. Most diagnoses are suggested by the history, with examination and investigation providing supporting and confirmatory evidence. By the same token, if doctors reach the end of the history without some idea as to the cause of the patient’s problem, they need to go back and retake it, because their chances of arriving at the correct diagnosis without this map to guide them are slim. History taking is a conversation with a purpose, not a cross-examination; as well as using questions, doctors often need to use other conversational devices to help the flow of information. This chapter looks at some aspects of history taking that are of particular relevance to diagnosis in internal medicine.