History taking

As a physician doing round every day and taking students from time to time.
I found a common weakness for my junior colleague (House officer) and students. Increasing House officer in ward make them taking care of only 6 patients per person but ironically they clark a poor quality of history.

History taking saves lives. proper history can anticipate severity of disease, diagnosis and give proper treatment to patient. MY FELLOW prof. teach me in my first lesson proper history taking which i think i need to share with my fellow juniors.
first, chief complaint!
4 C need to be applied for history taking- condition, cause, confirm and complication

Condition -for example, if pt complaint of chest pain then chest pain is the condition.then you need to ask every thing about chest pain (this condition) from character, onset, severity, associating condition eg sweating, vomiting..... plus precipitating and relieving factor

cause- try to establish the cause for example is it IHD, pneumonia, costocondritis

confirm the complaint- is it real chest pain or just diff in taking breath or worse underlying psychaitric cause! My experience, pt with underlying ischemic heart disease complaint of chest pain admitted for unstable angina when further history taking found wife had extra marital condition and ended up chest pain. ECG all normal. I refer psychiatrict and problem solved!

complication- pt if chest pain due to heart attack , maybe pt will collapse or got ventricular rupture......

This is the basis for clarking history, if provisional diagnosis already confirmed then need to get risk factor for the cause eg... heart attack - risk factor will be age, sex, diabetis, hypertension, smoking and family history......

If failed to obtain all this, it won't be good history.

One real story happening yesterday, patient presented with tremor but diagnosed by HO as stroke. On examination, pt got cog wheel rigidity worse on one side, mask like facies, bradykinesia. turn out to be Parkinson disease. This happens HO not bother to take proper history and PE!