Using examples rather than generalisations in history taking

When taking the history of the presenting complaint (whether for a physical, or a psychiatric presentation) as well as getting the physical details of illness, also get a history of how the child and family reacted to the various events that took place.

Patients are sometimes inclined to talk in very general terms about their problems

eg. a patient with asthma, when asked about his symptoms, might talk about the average asthma attack. 

Often more useful information can be obtained by getting the patient or parent to recount a particular episode.Find out where the episode occurred, what was happening before, who was around and who was not from the family, who was most worried, who decided when to bring a child into hospital, did anyone think the illness should have been managed differently.

This is especially the case when parents present children with behaviour problems.  In such situations we often hear a long list of difficulties that the child presents and it is easy to be overwhelmed by such a list.  It can be useful to ask the parent to tell us about a particular example of one problem. 

For example a child who is fighting, failing at school and having tantrums at home, the doctor can nominate or ask the parent to nominate which area is the most important and ask for particular detail about the last time the problem occurred. 

Going into detail about this one example is often more revealing than hearing an overview of the various problems.

Also consider ‘attribution’:

What do the child and the family understand to be the origin of the illness?

This may differ greatly from your understanding, eg, it may have spiritual or superstitious components. Your capacity to treat your patients will be compromised if you don’t know how they make sense of their experience and achieve some consensus.