Chapter II HISTORY OF PATIENT
An orderly routine procedure in questioning and examining the patient is of the utmost importance. To facilitate this, many physicians use a card on which is taken the preliminary history of the patient. These cards are particularly useful in seeing patients at the bedside or anywhere away from the office.
<Callout type="important" title="Inquire Thoroughly">It is important to make such inquiries as to the health and age of parents, paternal and maternal grandparents, uncles, aunts, and cousins, as will give the physician a clear idea as to the nature of the material with which he is dealing.</Callout>
Of greater importance than this is the question of direct exposure to infection from actual cases of tuberculosis in the family. It is not enough to be satisfied with a negative answer to the stock question, ‘‘Is there any consumption in your family?’’ The physician should inquire carefully into the present state of health of each member, the exact cause of death if any have died, and, above all, he should make sure that the disease is not hidden under euphonious terms such as ‘decline,’’ chronic bronchitis,’’ weak lungs,’’ dyspepsia,’’ nervousness,’’ anemia,’’ ete.
In dealing with tuberculosis the basis on which correct diagnosis rests is a careful, thorough, detailed history of the patient and his family, occupation, family habits and surroundings. Heredity plays a significant role in predisposing individuals to tuberculosis. A case study involving five sons all well and strong and four daughters, two of whom have already died of consumption, one is now dying and the other sickly, highlights the importance of hereditary factors.
<Callout type="risk" title="Hidden Infections">It often happens that a patient gives what seems like a very bad family history, and yet on careful questioning is found to have been remarkably free from any real exposure to the disease.</Callout>
Of the diseases and abnormal conditions apt to come later in life there are five which are of special importance as related to a possible tuberculosis. These are (1) ‘‘pleurisy’’; (2) ‘influenza’’; (3) ‘‘bronchitis’; (4) ‘‘run-down’’; (5) ‘‘fever’’ or ‘* slow fever.’’
<Callout type="tip" title="Occupational Hazards">In inquiring as to the occupation of any given patient, it is important to find out not only the trade or profession by which the patient earns his living but also what he actually does during his working hours. Much has been written concerning the so-called dangerous trades.</Callout>
Whether a patient has had tuberculosis elsewhere in the body is usually evident on careful scrutiny without questions. Enlarged glands, scars or sinuses speak for themselves. It is not safe to rely on this but far wiser to ask direct questions as to whether or not at any time the patient has had tuberculosis or conditions caused by tuberculosis elsewhere than in the lungs.
Among other routine questions which it is well to ask the patient is one somewhat as follows: ‘‘Did you consider yourself up to the present time of the strong, rugged and robust type, the thin but wiry type, or were you always rather delicate?’’ If the patient admits to being in the latter class, one should then inquire as to how often and how long he or she has been confined to bed with minor illnesses.
In addition to the routine questions as to alcohol, tobacco, tea and coffee, the question of syphilis should be carefully gone into. Pulmonary syphilis is not such a rare condition as has usually been supposed and many a so-called consumptive has been cured by iodide of potassium and mercury. In addition there are two other ‘‘habits’’ concerning which inquiry should be made, the ‘‘fresh air habit’’ and the ‘‘fresh water habit.’? In other words, it is well to find out whether the patient is one who loves to get out of doors and into the country whenever possible, who likes walking and exercise, or is one who prefers to sit indoors at home; likewise it is important to find out what sort of a bath the patient takes, and whether or not he wakes up the skin, the lungs and the whole body with a cold bath and rub down in the morning.
All the information concerning the patient’s occupation, home surroundings and habits obtained in logical and orderly sequence will go a long way in making the final decision as to diagnosis and treatment a correct one.
Key Takeaways
- Gather detailed family, occupational, and personal histories for accurate tuberculosis diagnosis.
- Inquire about direct exposure to infection within the family.
- Consider hereditary factors in predisposing individuals to tuberculosis.
Practical Tips
- Always ask follow-up questions when a patient gives a negative family history of tuberculosis to uncover any hidden infections.
- Evaluate both the working conditions and home environment for potential occupational hazards that could contribute to tuberculosis.
- Include questions about sexual habits and bathing routines as part of the comprehensive patient history.
Warnings & Risks
- Be cautious when relying solely on a negative family history, as patients may have been exposed without realizing it.
- Avoid overlooking the importance of hereditary factors in diagnosing tuberculosis.
- Do not assume that all trades are dangerous; carefully assess working conditions to determine risk.
Modern Application
While the techniques for gathering patient histories remain relevant, modern diagnostic tools and treatments have advanced significantly. This chapter still provides a foundation for thorough patient assessment but should be supplemented with current medical practices and technologies.
Frequently Asked Questions
Q: How can a physician determine if a patient has had tuberculosis elsewhere in the body?
Enlarged glands, scars or sinuses speak for themselves. It is not safe to rely on this but far wiser to ask direct questions as to whether or not at any time the patient has had tuberculosis or conditions caused by tuberculosis elsewhere than in the lungs.
Q: What are some important points concerning which inquiry should be made when gathering a patient's history?
Pleurisy, influenza, bronchitis, ‘‘run-down’’ and ‘‘fever’’ are important points concerning which inquiry should be made.
Q: Why is it important to inquire about the occupation of a patient in diagnosing tuberculosis?
In inquiring as to the occupation of any given patient, it is important to find out not only the trade or profession by which the patient earns his living but also what he actually does during his working hours. Much has been written concerning the so-called dangerous trades.