Examination of the Patient

Before treating the patient it is necessary to make a correct diagnosis of the disease and to determine its aetiology, i.e. the causes of the disease. The doctor must know well the pathogenesis of any disease, i.e. the way and mechanism of its development, as well as the symptoms by which it can be revealed.

A number of different procedures is used to establish a diagnosis: history- taking, physical examination, which includes visual examination, palpation, percussion, auscultation, laboratory studies, consisting of urinalysis, blood, sputum and other analyses; instrumental studies, for example, taking electrocardiograms or cystoscopy, X-ray examination and others. For determining a disease it is very important to know its symptoms such as breathlessness, edema, cough, vomiting, fever, haemorrhage, headache and others. Some of these symptoms are objective, for example, haemorrhage or vomiting, because they are determined by objective study, while others, such as headache or dizziness are subjective, since they are evident only to the patient.

Taking a Case History

Case histories are biographical accounts of a patient by his doctor containing all information about his past and present that helps the physician understand the patient's health problems. A patient is asked to give such an account upon his first visit to a doctor or admission to a hospital. If he comes with a specific complaint he will, of course, be asked to tell his symptoms, any treatment or medicine he is taking and how long he had the complaint. If he comes for a check up, the interview may begin with a series of more general questions about the patient's home, work and marital status.

When enquiring into the history, the physician must inform himself about the health of other members of the family (family history), paying particular attention to the incidence of tuberculosis, mental disease, malformations, metabolic diseases, and syphilis.

From the patient's statements, information should be obtained as to past illnesses (children's diseases, poliomyelitis, rickets, wounds, accidents, operations, internal diseases), his occupation (there may be reason to recommend a change of work), his habits (alcohol, smoking) and any venereal disease.

The history, consisting of the hereditary and family history, the personal history and the present complaint must be entered accurately on a case-sheet for the information of the physician and other investigators.

In most hospitals there is a form which includes, among other things, the special points about which questions must be asked, which depend on the specialty dealt with.

General symptoms, such as pronounced gain or loss of weight, continuously high temperature, pain, loss of appetite, disturbances of sleep, abnormal thirst, and digestive disturbances should be dealt with first, going on to the special symptoms afterwards. Questions about the special symptoms should deal with the individual systems (respiratory, digestive, urogenital, peripheral and central nervous systems, locomotor system, etc.). Examination begins after taking the history.