Structure of the Case History Interview

 
The case history interview should be initially unstructured and open ended. Patients should be allowed to tell their story with minimal interruption. One approach is to ask the patient, “Tell me, what brings you here?” It is helpful to ask patients to start at the beginning and present their story chronologically. Patients should be asked to present their symptoms as they experience them and to avoid using any medical diagnoses they may have been given.

Once patients have presented their own interpretation of the symptoms, a review of previous medical testing and a series of pointed questions to gain additional details are usually required. Although most patients respond appropriately to the questions, some need to be refocused frequently and instructed to listen closely to the question being asked, restricting the answers to addressing only the specific question. Using the questionnaire as a guide, it is the job of the examiner to extract the necessary information from the patient in an effort to categorize the patient’s “type” of dizziness before beginning any examination.

Some patients may attempt to self diagnose, and hope that you agree with their conclusion. They may say something like “I think it’s my sinuses, what do you think?”  Another common obstacle to overcome is when a patient starts with “My neighbor had dizziness and he…”  Other patients may tell you about a previous diagnosis they have received for the symptoms described.  Most often, I sit patiently and let them tell me whatever they think is important, then I ask the questions that will provide pertinent information. Occasionally, I will have to kindly steer the conversation to make any productive headway.

Information should be obtained regarding the quality and temporal course of symptoms; precipitating, exacerbating, and relieving factors; associated symptoms; and the patient’s general health status. Next week we will delve in to more detail on each of these.