The art of taking a history
Author: TG Graboys
Reference: Journal of Myocardial Ischemia 1992; 4(9): 14
Excerpt from an interview with Dr. Bernard Lown, Founder and Chair of ProCor, conducted by Dr. Thomas Graboys, President of the Lown Cardiovascular Research Foundation.
A wonderful exercise in communication
Dr. Lown: "To me, the art of history taking is a wonderful exercise in communication. I had a friend, a very bright physician, who was trying to computerize the history. This notion upset me very much, and one day we had a heated discussion about it. My friend defended his idea by saying that the computer would be thorough and would not miss anything. In response, I related an experience I ahd had recently with a new patient. I asked this patient, "Do you have any discomfort behind the breast bone?" And the patient answered, "No." But something about the way he responded caused me to probe further. "Tell me about it." I said. "Well, it wasn't really a discomfort. It was a sort of heaviness," was his reply. "How would your computer have responded to the ‘no'?" I asked my friend.
"The crucial point here is that when you talk to a patient, you're constantly listening, not only with your ears, but with all your powers of observation. You're listening between the lines. And you're also carefully watching the patient when he isn't speaking. You're looking at the eyes, the face, the body language. You're aware of what angina feels like. And when you are, rarely do you make a wrong diagnosis, rarely. People tell me that angina is difficult to diagnose. I don't believe that."