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CMAJ • March 6, 2001; 164 (5)
© 2001 Canadian Medical Association or its licensors

Review
Synthèse

Problems for clinical judgement: 1. Eliciting an insightful history of present illness

Donald A. Redelmeier*{dagger}{ddagger}, Michael J. Schull*{dagger}, Janet E. Hux*{dagger}{ddagger}, Jack V. Tu*{dagger}{ddagger} and Lorraine E. Ferris{dagger}{ddagger}

From *the Department of Medicine, University of Toronto, Toronto, Ont.; {dagger}the Division of Clinical Epidemiology and Health Care Research, Sunnybrook & Women's College Health Sciences Centre, Toronto, Ont.; and {ddagger}the Departments of Health Administration and Public Health Sciences, University of Toronto, Toronto, Ont.

Abstract

THIS ARTICLE PRESENTS THE RESULTS OF A REVIEW of studies of psychology that describe how ordinary human reasoning may lead patients to provide an unreliable history of present illness. Patients make errors because of mistakes in comprehension, recall, evaluation and expression. Comprehension of a question changes depending on ambiguities in the language used and conversational norms. Recall fails through the forgetting of relevant information and through automatic shortcuts to memory. Evaluation can be mistaken because of shifting social comparisons and faulty personal beliefs. Expression is influenced by moods and ignoble failures. We suggest that an awareness of how people report current symptoms and events is an important clinical skill that can be enhanced by knowledge of selected studies in psychology. These insights might help clinicians avoid mistakes when eliciting a patient's history of present illness.




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