Patients most often seek care for a particular problem - a disease, illness or injury. However, these problems cannot be treated in isolation. A patient may have more than one problem, and so these problems interact making management more complicated. Also, a patient's response to disease, and so their needs, are effected by their previous experiences. For example, someone who is being hospitalized for the first time might be quite fearful of the process, whereas someone who has been hospitalized previously may not be so concerned. Conversely, someone who is used to good health and quite confident of their well-being may face disease or injury with confidence, whereas someone who has had a series of problems may have feelings of depression and helplessness. These considerations mean that the patient's health history can give important clues to the special needs of the individual patient.

The health history is also important in identifying diseases which are hard to diagnose. The careful history may reveal special characteristics, such as a pattern of recurrences, or provoking factors which help to refine the diagnosis.

The health history is also important in determining the prognosis. The same disease may not follow the same natural course in every patient. For example, in some patients rheumatoid arthritis quickly becomes a disabling and disfiguring disease. In others, it may be relatively mild and the patient may enjoy long periods when they are free of symptoms. Knowing how the disease has progressed in the patient in the past is a good clue to how the disease will progress in the future.

A person's health history can be very complex, especially if they are an older person. You cannot ask about everything that has happened in their past. Your questions will be guided by the patient's chief complaint. It is a good rule, however, to start with fairly general questions, and then follow these with more focused questions as pertinent information emerges. Your primary concern must be the chief complaint. On the initial visit, once you have enough information to deal with the chief complaint confidently, do not spend unnecessary time probing for details which will not effect patient care. You can always build the health history on subsequent visits.

Situation 1: A well patient is having a pre-employment screening examination performed by a nurse.

Nurse: Mr. Smith, I would like to ask you a few questions about your health history. Is that alright?

Mr. Smith: Sure, go right ahead. But I've always been quite healthy.

Nurse: Mr. Smith, have you ever been hospitalized?

Mr. Smith: I have only been in hospital once, when I was a kid. I had my appendix removed. Otherwise, I have always been pretty fit.

Nurse: Have you had any other operations?

Mr. Smith: No, that was the only one. I've always been pretty healthy.

Nurse: Have you ever had any other serious illnesses?

Mr. Smith: Just the normal childhood diseases. Never anything serious.

Nurse: Mr. Smith, I am going to show you a list of diseases. Can you tell me if you have had any of these? (The nurse runs down a list of diseases.)

Nurse: Diseases of the ears, eyes, nose or throat?

Mr. Smith: No.

Nurse: Disorders of breathing: asthma, bronchitis, emphysema?

Mr. Smith: No.

The nurse continues until she finishes the list.

Nurse: Well, Mr. Smith, you do seem quite healthy.

Mr. Smith: (Joking) I told you so.

Nurse: Are you taking any medication right now?

Mr. Smith: No, nothing.

Nurse: Good. Now if you will just step into the examination room, the doctor would like to take a look at you.

Patterns:

*Have you ever
... been hospitalized
... been in hospital
... been seriously ill

* I have only
... been hospitalized once
... been in hospital once
... been seriously ill once

* Have you had
... any other operations
... any other serious illnesses

* I have always been
... quite healthy
... pretty healthy
... pretty fit

* Can you tell me/Please tell me/ Tell me
... if you have had any of these