The importance of history taking
Identify a central concern
Chiropractors are primary health care providers, and as such it is our role to correctly
identify patient’s symptoms and formulate a diagnosis or working diagnosis based on the
information provided during their treatment sessions. It is also a Chiropractor’s
responsibility to recognise very serious, perhaps life-threatening illness early.
The central concern is having the skills to obtain a thorough clinical history, which is
the first step to formulating an accurate diagnosis. According to "The importance of the
history and physical in diagnosis", 2014 less most patients present in clinic with multiple
concerns, which can make it challenging to focus the discussion without losing important
information regarding the patient’s healthcare issues and concerns. Furthermore, some
experts note that contrary to common opinion, most patients do not communicate their
primary concern first, and therefore, their most serious symptoms are often left until the
end of the appointment or are not addressed at all.
Research a strategy to address central concern/Implement change strategy to address
central concern
A change strategy to help address this central concern is to ensure you take a careful
history. A careful history will usually indicate the diagnosis or narrow it down to three
differentials. Physical examination and imaging may then be used to “confirm” the
suspicion. Several strategies can help the Chiropractor refine the art of history taking.
The pneumonic LODCTRRAPPA can be used with the purpose to pinpoint the location
and origin of the patient’s pain. The Chiropractor asks questions to clarify the patient’s main
complaint. The pneumonic stands for location, onset, duration, course, type, radiation,
relieving, alleviating/aggravating, previous treatment, previous episodes, and associated
symptoms.
Once the Chiropractor asks the questions it is important to let the patient describe
the quality and character of their symptoms in their own words. According to "The
importance of the history and physical in diagnosis", 2014 less than 2% of patients will
complete their initial statements once they are interrupted. This results in the Chiropractor
only having part of the information and can also result in a disagreement between patients
and providers views of the illness and the purpose of the visit.
An example of this is if a patient presents with the complaint “dizzy”. The
Chiropractor should avoid asking the patient leading questions such as “does the room
spin”, “do you feel faint”, or “do you feel anxious or scared”. When asked these leading
questions a patient is likely to answer yes to the majority of these questions. The
Chiropractor should ask the patient “what do you mean dizzy?”, and wait for the patient to
provide a response, no matter how long it may take as this will likely result in the patient
defining the cause of their symptoms. For example, light headedness suggests a
cardiovascular cause, a sensation of motion suggests a vestibular cause, and disequilibrium
suggests a neurological cause.
Another strategy is to ensure you obtain a patient’s entire agenda of concerns at the
beginning of the appointment as this will not only help with the most accurate diagnosis and
treatment, but also improve time management (The importance of the history and physical
in diagnosis, 2014).
Throughout the process of eliciting a history it is also important to consider the
culture of the patient. For example, Aboriginal and Torres Straight Islander people are often
reluctant to engage in conversations that reflect negative health outcomes for themselves
and their families ("Death & Dying in Aboriginal & Torres Straight Islander Culture", 2015) . This can
make it difficult to discuss serious medical diagnosis and complications. It is therefore
important as a Chiropractor to be culturally understanding and establish respect for the
beliefs of the patient in order to establish trust, which will lead to better communication
with the patient.
Reassess if change strategy has been successful
Determining whether these change strategies have been successful is an ongoing
process. In class, when we practice eliciting a history I have implemented asking open ended
questions and waiting for the patients response without interrupting them. This isn’t always
easy however and is a skill I feel will be developed over time.
References
Death & Dying in Aboriginal & Torres Straight Islander Culture. (2015). Retrieved 2
September 2020, from http://www.nslhd.health.nsw.gov.au/
The importance of the history and physical in diagnosis. (2014). The Nurse
Practitioner, 39(4), 35-36. doi:10.1097/01.npr.0000445726.93236.5e
