When i started this blog i never intended to make it a clinical blog. I just wanted to write.. But now i find myself relating almost entirely my clinical experience. After all that is what my life revolves around. That is the reason i spend most of the nights sleepless.... the cause I've had no real holiday in eons...
Anyway back to history.
As i was saying the other day, the gog and magog of a history is the presenting complaint and the history of presenting complaint.
* The presenting complaint is the opening.. The beginning.. And a bad beginning would inevitably lead way to a series of unfortunate events. ;P So it must be perfect. Like a woman's clothing, it should reveal just sufficient to give you an overall idea of the patient.
Essentially it should contain the patient's details in summary and his main complaint.
The text books say, it should contain the reason for hospital admission.
It would be quite a piece of cake in a senario like, " 75, year old mr. Nandadasa, presenting with acute abdominal pain of 6 hours duration.."
But yesterday i met a patient who told his story this way..
me: so, mr. G, what is you problem?
mr. G: Ahh, I had abdominal pain for the past 6 months.
me: Do you have abdominal pain still. Where does it hurt?
Mr. G: It doesn't exactly hurt now.. Well now after the fall of course my back hurts.
me: A fall? So did you get admitted because you fell?
Mr. G: No it was a near thing.. But still, ain't it?

And all the while the patient had gotten admitted for something completely different most likely.
After you somehow get why the patient got admitted, your whole life centers around that. The history of presenting complaint should elaborate the complaint like a story... But a most logical and systematic story it should be..
I would so like to go on about the history of presenting complaint too now, but after a busy casualty day and night I'm afraid I'm just too tired... A whole day...listening to patients, taking histories painstakingly, only to be laughed at by the registrar upwards is a very rewarding and morally satisfying passtime i guess..
Right now I'm in dire need of a room of requirements of which i could shut the door and sleep till i wake a natural waking... But alas.... sleep my dear friends is a luxury which is not for us in purgatory...