During the history-taking you are allowing the patient the first opportunity to explain their symptom in their own words. If the patient does not do so of their own accord, you should ask the following questions:
- when did the symptom develop
- how did the symptom develop (suddenly, quite suddenly, gradually)
- what was the patient doing when the symptom developed (emotion, exertion, sleep, etc.)
- how did the symptom progress over time (constant, slowly or rapidly worsening, in episodes)
- which circumstances affected the symptom (posture, coughing, sneezing, bearing down, flashing lights etc.)
Research has shown that relatively experienced doctors draw up a hypothesis or a number of hypotheses during this phase of the history-taking, taking into account any prior knowledge they may have of the patient, the patient’s age and sex and the prior risk of developing a particular disease. Further history-taking and the physical examination are used primarily to test this hypothesis or hypotheses. The more knowledge a doctor has of the different clinical pictures, the more targeted the history-taking and examination can be. If for example, the patient complains of headache which occurs in episodes, one of the doctor’s hypotheses will be ‘migraine’. The doctor will then ask whether auras occur, the precise location of the pain, and whether they experience an adversity to light during the pain attack and whether there is a family history of migraine. They will ask this to make their hypothesis more or less likely.
In a number of cases questions can also be asked not with the sole intention to test a hypothesis, but to avoid missing any conditions. The doctor then asks about symptoms which the patient has not spontaneously mentioned, for example because the patient does not think they are relevant or because they are ashamed of them.
Symptoms which could indicate a disease involving the peripheral or central nervous system include:
- listlessness, loss of initiative
- memory and thought disturbances
- altered state of consciousness with or without convulsions
- headache
- visual disturbances
- auditory disturbances
- dizziness
- uncertainty when walking, clumsiness
- speech and swallowing disorders
- loss of strength
- involuntary movements
- impaired feeling or loss of feeing radiating pains in the limbs
- impaired bladder function.
Questions about other symptoms, the past medical history, medication use, habits, hereditary diseases, work and family are intended to provide the doctor with a profile of the patient and their health which is as complete as possible.