Obtaining a patient’s history is the first critical step in determining the patient’s illness. Most of the times, a good doctor swears by the fact, that a good history would be enough to make a good diagnosis, if not decrease the number of differential diagnoses. In medicine, a differential diagnoses is the process of distinguishing one disease from the other, especially when one symptom(s) is a part of several diseases. While not exactly arbitrary, broadly this exercise can be quite subjective and hence the emphasis on a protocol or evidence-based approach toward diagnosis.
Components of good history taking include:
1. Chief Complaint
-Symptom(s)
For what has the patient come to the clinic? Sometimes the patient may identify two or more conditions that they may wish to address. When this happens, we use the checklist in detail for each of the complaints.
-Duration
How long has this condition lasted for? What is its onset? What it is severity/ character?
-Location and Radiation
-Aggravating and relieving factors
Any home-based treatment to understand the course of illness.
2. Past History of similar or related complaint
3. Family History eg. High BP in family members
4. Personal/ Social History eg. habits such as alcohol, smoking, etc and drug allergies
In the Intelehealth platforms, HxGuide enables the task of history taking to shift to the CHWs (Community Health Workers). Thus the value of history taking will depend on the CHW’s ability to elicit relevant information. In HxGuide we have the required tools (clinical protocols) that will allow the CHW to obtain a relevant and detailed history via app prompts and we have also developed training programs for the CHWs that can be delivered periodically on newer updates or best practice procedures they can implement on the ground.
In short, the HxGuide is a clinical history taking protocol and akin to a checklist. It is a set of instructions or guidelines on what should be the next logical step, in this instance, what relevant detailed history should be inquired into and what is the process flow to follow. On the Intelehealth app platform, the clinical protocols are developed in a way that allows us to approach the patient’s concerns in a patient-centered and problem-oriented fashion. The patient initiates the HxGuide by describing a symptom. The CHW enters the common condition as presented by the patient and as per the prompts from the app continues to take the history further taking a complete detailed history.
Here’s an example of a CHW taking history and conducting a physical exam using the Intelehealth app’s HxGuide. This would guide the doctor’s diagnostic ability [link] to provide evidence-based care.
Pic: CHW with her tools (Backpack kit) explaining about the process, taking consent and explaining about data privacy of the data to be gathered in the session.
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Pic : CHW writing down the patient particulars and taking down the history
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