During the first contact between doctor and patient, getting to know each other plays a significant role. Only those who know they are in good hands with their doctor are willing to accept the diagnosis as well as the proposed therapy. It is also important for the doctor to know the patient well. The first conversation between doctor and patient is called anamnesis.
What is anamnesis?
It is important for the doctor to know the patient well. The first conversation between doctor and patient is called anamnesis. The doctor must not only know about the current complaints. There are various causes behind the same symptoms. The anamnesis provides him with an overview of the patient’s state of health, professional and personal living conditions and mental state. A thorough medical history forms the starting point for the type and scope of subsequent therapy. It helps the physician to make a clear diagnosis and to treat the patient effectively. The term anamnesis goes back to the Greek word “anámnēsis” and means “recollection”. It refers to both the interview and the content of the patient’s medical history. In an in-depth interview with the patient, a kind of “health resume” is created to gather and document basic medical information about the patient. Along the way, the physician has the opportunity to inspect his patient in advance (posture, facial color, condition of hair and fingernails). Another aim of the case history is to establish a positive relationship of trust between doctor and patient. This forms a crucial basis for later successful treatment.
Function, effect and goals
The medical history is taken before the medical examination. How it proceeds and how long it lasts depends on the symptoms of the sick person and the specialty of the doctor. His goal, together with the patient’s medical history and physical examination, is to find an initial tentative diagnosis. He can confirm this with additional examinations and initiate an effective therapy. Depending on where the information comes from, the physician differentiates between self-reporting and external history taking. The former is based on the patient’s own answers. An external anamnesis comes from people in his or her immediate environment. This is necessary if the patient is unable to communicate adequately or if symptoms occur that he does not notice himself, for example, because they occur during sleep. The doctor greets his patient with the question, “What brings you to me?” and listens to his complaints. He asks specific questions that narrow down the diagnosis and cover the relevant areas of the patient’s history. The Current History includes questions that target current complaints: Where does it hurt and since when? How severe is the pain? When and how often does it occur? All answers that do not relate directly to this are the subject of the “General medical history”. This first examines the patient’s past medical history. It covers illnesses that the patient has been through, chronic illnesses, infectious diseases and childhood illnesses, previous operations, injuries, allergies or disabilities. The vegetative history focuses on bodily functions such as eating habits, bowel movements, breathing and sleep. For example, the physician inquires whether the patient suffers from nausea, loss of appetite, dizziness or sleep disturbances. During the medication history, the physician is interested in which preparations the patient is taking or has taken, for what reason and in what dosage. Unfortunately, patients often forget to mention over-the-counter preparations or contraceptives such as the pill. But for the doctor, these details are important. These agents can interfere with the effect of other medications. By taking a history of stimulants, the doctor can assess possible risk factors. Alcohol, drugs or cigarettes trigger or aggravate certain diseases, as does excessive coffee or sugar consumption. Especially when it comes to these “sensitive” topics, a trusting relationship between doctor and patient is of great importance. Questions concerning the patient’s physical condition are summarized in the Somatic Anamnesis. In contrast, the Psychological Anamnesis analyzes his or her mental condition. Most people are rather uncomfortable with these questions. However, those who feel that the doctor understands and cares about them are more willing to talk about stressful circumstances or feelings. Another chapter is the social history.It provides information about the patient’s social environment, occupational and family situation. Certain factors in the occupation give rise to occupational diseases such as asthma in bakers or bricklayers. Similarly, high physical and mental stress at work or family conflicts trigger health disorders. The family anamnesis gets to the bottom of genetic risks. It looks for hereditary diseases and predispositions to certain illnesses such as rheumatism, diabetes, cancer or mental disorders. These often occur in clusters in the same family. In addition, people within the family can contract infectious diseases. Therefore, the doctor inquires about diseases of living relatives and the causes of death of deceased relatives.
Risks, side effects, and dangers
All these answers provide important clues to the possible causes of the current symptoms. The success of subsequent therapy depends crucially on what clues the physician obtains during the medical history and physical examination. Therefore, he will conduct the survey differently depending on the symptoms, his area of expertise and his experience. 90% of all diagnoses are based on a conclusive combination of history and physical examination. This assumes that all the information provided by the patient has been correctly received by the physician. Rarely do misunderstandings or unconsciously incorrect information from the patient lead to incorrect diagnoses. A good physician is able to filter out the decisive information from the variety of information, interpret it correctly and make an accurate diagnosis.
