Guidelines for giving a medical history
The most important part of the doctor patient interaction is the medical history.
I have been taking medical histories for almost thirty years. If the patient and the doctor can get a precise timeline, accurate descriptions of all the important events then the interaction was a success. I was the first physician in Illinois to diagnose a case of confirmed Lymes disease. Why did 8 other dedicated physicians miss the diagnosis? Because the medical history did not make sense and the timeline of her illness was not accurate. Please briefly review my suggestions below to see if we can make our interaction better for both of us.
“The trust forged in the initial doctor-patient relationship is often the key to a patient’s willingness to participate in, and benefit from, care provided by the doctor.”
The goal of the interview is to obtain personal and symptom information about the patient. The physician must interpret this data in light of his medical knowledge and formulates a description of the patient in biopsychosocial terms; that is, a medical history with integrated biological, psychological, and social history leading to the most likely diagnosis.
Chief Complaint We ask that patients who present with multiple complaints come up with one main reason they are being seen today. It helps to focus our thoughts and our history on what is really important to the patients. Many patients want to give me a diagnosis i.e. “Then I had a bad migraine.” I would rather you describe the symptoms and signs you had not your diagnosis of the illness.
History of Present illness We like to place things on a timeline so that they make sense with other parts of the history. It is important that we find out when you developed symptoms as it relates to other events. Often these other events seem unrelated. “I developed asthma 3 yrs ago. I moved into my sisters home 3 yrs ago. My sister has two cats.” Taken alone not very clear but when placed on a timeline we can see the cat exposure may have led to the development of asthma.
Food and Drug Allergy In some patients allergy mean reaction. It doesn’t. Allergy to a drug means the body has made an allergic antibody (IgE) response to a drug. This leads to allergic reactions and possibly a fatal anaphylaxis. A reaction to a drug may include allergy but more commonly it is a side effect such as “I got diarrhea on Augmentin”. Side effects or toxic effect do not mean you can never take the drug again but allergy often means a life long ban.
Past medical history We want to know what medical disease you have or had and how they are doing now. If your taking a medicine for high blood pressure and it is controlling the blood pressure it doesn’t mean you no longer have high blood pressure. Surgery and medical problems are best given with a timeline. We need to know if the diseases you have today are in part caused by past diseases or medications used to treat that disease.
Family history We use this critical information to guage your risk of developing a disease or in part more likely to have some features of your family illness. If you can find out what people in your family suffer from and when they developed this illness. .
“The medical interview has three functions: data gathering, relationship building, and patient education.”
When looking for Allergy or Asthma Relief make sure your seeing a Qualifiedand Knowledgeable Physican!
Top 5 Reasons Patients see an Allergist:
The allergic triad-Eczema-Rhinitis-Asthma. Eczema is that red, scaling, itchy rash that likes to develop in the skin folds of the elbow or knees or the sides of the face in infants. about 18% of the US population suffers from eczema. Allergic Rhinitis or Hay Fever affects almost 50% of all children, It is familiar to all of us with its sneezy, itchy, runny nose, and itchy watery eyes. patients often under appreciate it’s ability to cause feelings of depression, fatigue, poor sleep quality, and poor job or school performance. Asthma can be a lifelong problem in those children who wheeze thru high school. The chronic inflammation of the lungs can lead to permanent damage similar to smoking and ultimately lead to emphysema if not treated.
Food Allergy. The incidence of food allergy and food intolerance syndrome has risen at a dramatic rate. In the last 20 years we have see a quadruple increase in this food triggered event. With more that 170 foods capable of causing IgE-mediated reactions, pinpointing a patient’s trigger can be onerous. We carefully listen to our patients describe the signs and symptoms of their food induced reactions. We are interested in timing of food ingestion and food induced symptoms. We often note that the chance of allergic reactions rises if the person has been ill, under stress, changed hormones or ate several allergic foods at the same time.
Chronic Idiopathic Urticaria. This is defined as hive occurring almost for greater than six weeks. The patients need to tell us if individual lesions can last longer than 24 hours, are tender to touch, or lead to bruising as that may mean the patient has a more serious illness such as vasculitis. We now know that 50% of chronic hive patients actually have an autoimmune reaction to their own allergic system. This is similar to auto immunity in SLE or RA but it doesn’t involve inflamed joints just inflamed skin.
Chronic Rhino sinusitis. Patients give a history of frequent upper respiratory infections that fail to respond to medical therapy or never quite clear. They have an associated thick postnasal drip, nasal congestion, and a foreign-body sensation in the posterior pharynx. There also may be chronic headache, hyposmia/anosmia, and the presence of nasal polyps. They may have had sinus surgery in the past which may or may not have helped much.
Skin Rashes. This is a common problem in the allergist office. We look for drug allergy such as an antibiotic. We question all patients about drugs like Aspirin as that commonly causes allergic reactions in the skin and most people forget they even take Aspirin a couple of times a week. We treat viral infections of the skin, warts, hives, psoriasis and all sorts of contact allergy like nickel or chemical sensitivity.
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Helpful links with more inforamtion and patient help
American Academy of Allergy, Asthma & Immunology
The American Academy of Allergy, Asthma and Immunology is the largest professional medical specialty organization in the United States, representing allergists, asthma specialists, clinical immunologists, allied health professionals, and others with a special interest in the research and treatment of allergic disease. Established in 1943, the AAAAI has nearly 6,000 members in the United States, Canada and 60 other countries.
American College of Allergy, Asthma & Immunology
The ACAAI is a professional association of 4,000 allergists/immunologists. Established in 1942, the ACAAI is dedicated to improving the quality of patient care in allergy and immunology through research, advocacy and professional and public education.
The Food Allergy & Anaphylaxis Network
The Food Allergy & Anaphylaxis Network (FAAN) was established in 1991. FAAN’s membership now stands at more than 26,000 worldwide and includes families, dietitians, nurses, physicians, school staff, representatives from government agencies, and the food and pharmaceutical industries. FAAN serves as the communication link between the patient and others. The purpose of FAAN is to raise public awareness, to provide advocacy and education, and to advance research on behalf of all those affected by food allergies and anaphylaxis.
Allergy & Asthma Network Mothers of Asthmatics
Allergy & Asthma Network Mothers of Asthmatics (AANMA) is a nonprofit membership organization dedicated to eliminating suffering and death due to asthma and allergies through education, advocacy, community outreach, and research.
Allergic Living is the new health and lifestyle magazine created specifically for those living with food allergies, environmental allergies, celiac disease and gluten sensitivity. It’s easy to subscribe to Allergic Living and every issue is full of engaging, in-depth articles, advice from top experts and superb, allergy-safe recipes. Even without a subscrition you can search their recipe database and read articles online.
Asthma & Allergy Foundation of America
The Asthma and Allergy Foundation of America (AAFA), a not-for-profit organization founded in 1953, is the leading patient organization for people with asthma and allergies. AAFA provides practical information, community based services and support through a national network of chapters and support groups. AAFA develops health education, organizes state and national advocacy efforts and funds research to find better treatments and cures.
Whether you are new to food allergies or facing a new milestone, meeting other individuals and families who are in the same situation and sharing experiences and support can be incredibly helpful. It also helps to know you are not alone. To help you connect with a group in your area, FARE offers local contact information for support groups across the country. Use the search tool, below, to identify a support group near you and contact groups directly. The inclusion of a group on this voluntary listing does not imply endorsement by FARE. Support groups operate wholly independently from FARE. Be sure to contact your doctor if you have any questions, or before making any changes to your child’s diet
Joint Council of Allergy, Asthma & Immunology
JCAAI’s purpose is to provide a mechanism for keeping allergists/ immunologists abreast of the critical socio-economic issues which impact upon their practices. The JCAAI represents allergy/immunology in federal and state regulatory and governmental agencies, the Congress, in areas of reimbursement, and in other socio-economic areas where appropriate.
National Institute of Allergy and Infectious Diseases
The National Institute of Allergy and Infectious Diseases (NIAID) conducts and supports basic and applied research to better understand, treat, and ultimately prevent infectious, immunologic, and allergic diseases. For more than 50 years, NIAID research has led to new therapies, vaccines, diagnostic tests, and other technologies that have improved the health of millions of people in the United States and around the world.