Читать книгу Respiratory Medicine - Stephen J. Bourke - Страница 42

History taking is of paramount importance in the assessment of a patient with respiratory disease. Difficult diagnostic problems are more often solved by a carefully taken history than by laboratory tests. It is also during history taking that the doctor gets to know the patient and their fears and concerns. The relationship of trust thus established forms the basis of the therapeutic partnership.

The doctor should start by asking the patient to describe their symptoms in their own words. Listening to the patient’s account of the symptoms is an active process, in which the doctor is seeking clues to underlying processes, judging which items require further exploration and noting the patient’s attitude and anxieties. By carefully posing questions, the skilled clinician directs the patient to focus on pertinent points, to clarify crucial details and to explore areas of possible importance. History‐taking skills develop with experience and with a greater knowledge of respiratory disease.

It is important to appreciate the differences between symptoms, which are a patient’s subjective description of a change in the body or its functions that might indicate disease; signs, which are abnormal features noted by the doctor on examination; and tests, which are objective measurements undertaken at the bedside or in the diagnostic laboratory. Thus, for example, a patient might complain of pain on breathing, the doctor might elicit tenderness on pressing on the chest and an X‐ray might show a fractured rib.