Wednesday, July 01, 2009

Why the consultant must take the patient's history himself

It’s very common these days to find that busy consultants often do not take the patient’s history themselves. Because they are so busy and need to maximize their efficiency , usually the history is taken by an assistant or a nurse. This person has a standard preprinted form ; and asks questions mechanically to ensure that the form is completely filled. The patient then goes with this filled in form to see the consultant; who then proceeds to examine the patient and orders tests.

The advantage of this system is that is maximizes throughput for the consultant, who can then see about 10 patients in an hour. It also ensures that all the information in the form is completely and systematically filled out .

While many consultants will swear by this system because it's one they have used for many years, the sad truth is that this is not the best method for the patient. The quality of the patient's history depends to a large extent on the clinical expertise of the doctor asking the questions - and an experienced clinician is far better at this as compared to a junior doctor or a preprinted form. In fact I feel the distinguishing factor between an experienced doctor and a junior is that a good doctor knows how to take a history ; which questions to ask; and how to interpret these questions . Unfortunately , this is not something which can be taught easily ; and is not efficiently done with the check box system.

This is why in real life , when a patient is referred to a senior consultant, the one thing which this doctor will do ( which was often not done properly before ) is sit down and talk to the patient. Many more puzzling clinical problems are solved by a carefully taken history , rather than by ordering more lab tests or scans.

Not only will taking the history personally improve the care the patient gets, this history taking session is a great opportunity for the consultant to establish rapport with the patient and build trust and confidence in the doctor’s skills. It also gives the clinician a chance to connect with the patient and display empathy and compassion. This can be hard to do nowadays, when clinic visits have to be compressed within 10 minutes. Unfortunately , by not giving patients the time and respect that they deserve, we end up doing everyone a disservice.


  1. Really Great blog sir. Thanks for publishing..

  2. I am impressed with this site and the information, more amazing is that this blog is initiated by a doctor.

    I would like to share my experience of birthing in India. My first Gynaecologist was excellent, she gave me a lot of time to understand my history and took pains in herself recording it. She also told me about the worst case scenario, which were mostly extreme cases but made me prepare for the worst.

    Unfortunately I shifted to Chennai for my delivery, which most women in India do. There my mother-in-law took me to a doctor who had a 'lucky hand' for normal delivery. She had no time and overburdened with patienst precisely because she was well known for having a lucky hand. She had patients at a time inside her room. My case was a bit complicated, I had a borderline high BP and there was some confusion regarding the conception date. She had three scans done just to clear this confusion and because she was unable to remember and did not have the time to read my file.Every time I visited her after two weeks she wa asking for a scan.

    Finally on the delivery day I had to face some harshness from nurses but I delivered normally despite having given a time for Cesaerean.

    Fo Indians the empathy and compassion displayed by doctors to patients is reducing. However ironically many foriegn patients are coming to India for fertility treatment because the doctors are kind and compassionate to their needs.


Get A Free IVF Second Opinion

Dr Malpani would be happy to provide a second opinion on your problem.

Consult Now!