The History Is Most Important

The diagnosis and management of 630 medical outpatients was assessed. The history was the most important factor in diagnosis. It alone decided 56% of diagnoses and 46% of management. Physical examination decided only 17% of diagnoses and 17% of management. Routine CBC and urine contributed less than 1% of all diagnoses. "Much greater emphasis should be placed on the diagnostic and management value of the history. Students, and postgraduates, should be well trained in taking a good history and in drawing diagnostic conclusions from the history before embarking on the examination. This will encourage the student to seek specific examination findings to confirm or refute the diagnosis based on the history. The traditional case presentation of history and examination followed by differential diagnosis should be changed to history, differential diagnosis and relevant examination findings."