Clinical history
Clinical history
Clinical history (pronunciation: /ˈklɪnɪkəl ˈhɪstəri/), also known as medical history, is a detailed account of a patient's past and present medical conditions. It is a crucial part of the patient evaluation process and aids healthcare professionals in diagnosing and treating diseases.
Etymology
The term "clinical" originates from the Greek word "klinikos", which means "bed". This refers to the practice of treating patients who were bedridden. "History" comes from the Greek word "historia", meaning "inquiry" or "knowledge acquired by investigation". Thus, a clinical history is an investigation into a patient's medical past.
Components of a Clinical History
A comprehensive clinical history includes several components:
- Chief complaint: The main symptom or health issue that led the patient to seek medical attention.
- History of present illness: A detailed description of the patient's current illness, including the onset, duration, intensity, and any associated symptoms.
- Past medical history: Information about the patient's previous illnesses, surgeries, allergies, and medications.
- Family history: Health information about the patient's immediate family members, which can help identify genetic or hereditary conditions.
- Social history: Information about the patient's lifestyle, such as occupation, diet, exercise, and use of tobacco, alcohol, or illicit drugs.
- Review of systems: A systematic inquiry about different organ systems to identify undiagnosed or unnoticed problems.
Importance of Clinical History
A thorough clinical history allows healthcare professionals to understand the patient's condition better and make accurate diagnoses. It can reveal patterns, risk factors, and potential causes of the patient's illness. Moreover, it guides the selection of appropriate diagnostic tests and treatments.
Related Terms
External links
- Medical encyclopedia article on Clinical history
- Wikipedia's article - Clinical history
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