Case history

A case history is more than a list of symptoms. It is the history of the disease, with all facts of medical importance in the life of the patient, and with information about how the patient is living through the disease. During the writing of the case history a doctor collects precious medical information, such as timing of the illness, how it manifested itself, and its evolution. In this period the doctor also has the possibility of creating a relation with the patient. This relation will successively become stronger and will be based on trust and esteem.

It is important that the doctor make the patient feel comfortable, regardless of the circumstances in which they meet. The patient should have the opportunity to tell his version of the disease without being interrupted. During the telling, only if pertinent, the doctor should express his/her sympathy for the patient, and try to encourage him.

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