WHY IS IT AN ART AND NOT MERELY A SCIENCE?
Well, history taking is an art simply because you can never be perfect in it. In any art, perfection can only be an ideal. One can only work towards it without ever achieving it. An artist, in the strictest sense will always be a student. Also an art cannot exactly be taught. Different people perceive it differently. It is for the interested individual to persue and learn the art himself. The same holds good when pursuing the art of history taking.
Medical students working in the wards should keep their eyes and ears open all the time and be constantly on the lookout for useful bits of information coming from any source. A pearl of wisdom might come forth from an experienced teacher at any time and not be repeated again. Such bits of common sense might come forth even from the ward nurse or the patient himself. If the student latches on to all such information that comes his way, in time a rich and highly useful bank of clinical information will be at his/her disposal. This will assist the student in gaining new insight into the patient's predicament.
History taking can never be mastered by anybody without being able to speak the patient's language. In fact, history taking involves the art of communication as well. Communication is well nigh impossible if there is a language barrier. Hence, a medical student working in the ward should make every effort to learn the local language. For example, there is no excuse for a student from a Hindi speaking state not knowing Kannada if he is studying in Bangalore and vice versa. Using a translator can only be a temporary arrangement. Unfortunately, I have seen students going through the whole medical course without learning even bits of the local language. Perhaps this is a sign of the times we live in where standards expected are being lowered all the time. I am afraid their time in the wards was simply wasted. On the other hand, there is no point expecting the patient to learn doctor's language. It will never happen. The mountain does not come to Muhmad!
Last but not least, one should provide adequate privacy in the examination room for the patient to feel comfortable and be able to come out with details of his trouble and innermost anxieties. The quality of history taken in a crowded and noisy outpatient clinic is not likely to be of the highest order.
Once you have the right attitude and the necessary linguistic as well as communicative skills you are on your way to be the maestro. It is not easy to be able to collect a good history. But I can assure you that the satisfaction that comes out of being able to take a good history and thus help in making an accurate diagnosis will more than compensate for the effort put in.
I have a small piece of advice before proceeding to history proper. It is said “Common sense in an uncommon degree is what the world calls wisdom”. Apply your common sense at every step and you will slowly find out that clinical surgery is nothing but collection of small bits of common sense applied judiciously. In surgery most of the disease processes occur at a macro level and affect an anatomical organ that can easily be visualised. An adequate knowledge of the functional anatomy of particular organ will enable the clinician to visualise the symptoms the disease affecting it is likely to produce. Such knowledge is definitely the forerunner of a well taken history. I will not be surprised if after reading this book you feel that you already knew every bit of what is written in this book. It is then only a case of practising what we already know. That should not be too difficult. Come on, lets get started.