The Art of History Taking Kashinath Padhiary
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1The Art of History Taking2
3The Art of History Taking
Second Edition
Kashinath Padhiary MD FICP FCCP Professor of Medicine MKCG Medical College, Berhampur Cuttack, Orissa, India
4
Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
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The Art of History Taking
© 2009, Kashinath Padhiary
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher.
First Edition: 2004
Second Edition: 2009
9788184486223
Typeset at JPBMP typesetting unit
Printed at
5To
My students …
“Dear students
Nobody can teach you
Unless you try to learn
What a teacher can teach
He can only expose your ignorance
Don't expect too much from the teacher
Because his knowledge is also limited
Rather, try to learn from the books
Under the guidance of your teacher
Never compromise the quality in learning
As the future (treating and teaching)
will be in your hand
We may not be excellent
But we all have a scope to excel”
6
7PREFACE TO THE SECOND EDITION
The first edition of the book was a success across the world. In this edition, I have tried to improve the language and included a chapter on Fever on request of my students, which will be very useful not only to the students but also the practitioners.
A chapter on hematology has also been added. Though hematological diseases form a small group of diseases, but history taking is very important for diagnosis. I feel after finishing the chapter one will certainly realize this. If anything is more important than history taking in such conditions, it is the detail blood analysis, particularly the peripheral smear. Excluding the addition of these two chapters, many other points in other chapters have also been clarified.
The evaluation and documentation of the chief complaints have been dealt with some details. The doubts about the leading questions have been clarified. How to avoid leading questions and how to interpret the answers to the leading questions have been discussed. A new entity in the name of community history has been added which in the previous edition was included in the family history.
I hope readers will find this edition more informative than the last one.
I shall be happy if I get suggestions from the readers about improving the text in future editions of the book.
Kashinath Padhiary8
9PREFACE TO THE FIRST EDITION
Is there a need for such a book?
With the progress of scientific knowledge more and more investigative procedures are available. These investigations have helped to reach at a more complete diagnosis, but simultaneously have increased the total cost of therapy. It is my observation that younger generations of doctors are becoming more and more dependent on these investigations. Investigations always do not give clear picture; at times confusing information is obtained where standardized laboratories are very few. These young doctors do not realize how much information can be obtained from a well taken history and how it can limit the number of investigations; thereby reducing the cost of therapy. Worldwide it has been felt that there is an absolute need to reduce the cost of therapy. I have tried to explain the amount of information we can get from history in few important systems; but importance of history is very much there in each and every case, medical, surgical or gynecological or in other fields.
It is my observation over the years that undergraduate students take a bizarre history. Postgraduate students also take history without knowing the importance of every aspect of the history. Often teachers just tell the students to collect the history without teaching them how to take the history, nor guide them while they are taking history. In view of PG students, I have noticed that this is the practice more or less everywhere. In fact, I have seen teachers giving undue importance to physical examination and investigations. 10None of the commonly available books of clinical methods describe the intricacies of history taking. The pages covered for history taking in these books is much less in comparison to the pages covered for physical examination. When the same thing is repeated at bedside, students fail to realize the importance of history. At times confusing things happen. For example, in history of present illness, no leading questions should be asked, but in practice almost all physicians ask leading questions. A beginner gets confused by that. Similarly, chief complaints are supposed to be recorded in patient's own language, but often the language the patient uses is not understood well, nor there is a scientific counterpart available in the books. So the information collected does not serve any purpose.
There are several other points which need clarifications. I shall try to discuss these points so that the students will be able to collect a fairly informative history. This book cannot teach the total aspects of history taking. Once the students realize the importance of history they can take better history than I can describe or anybody can teach. I hope this book will be of use to all the students of medicine.
Kashinath Padhiary