I once accompanied my father to an emergency room visit for chest pain. I paid special attention to his answers to the staff’s questions so I could fill in if he left anything out.
The first person to quiz him was a receptionist. He answered all of the questions patiently and correctly.
After being escorted to an examination room a nurse entered and asked the same questions again. Daddy was patient, but I noticed there was a slight variation to his answers, even though the questions had not changed.
Minutes count in chest pain patients who are experiencing a heart attack, and Daddy has had several, so a physician soon entered. As he examined, the doctor asked the same questions that had been asked previously. Again, the answers changed just a little.
Preliminary indications were that no cardiac event was occurring, but hospitalization followed as a precaution. Once on the floor, a nurse asked those now-familiar questions again.
And, once again, the answers changed just a little. Not from impatience. Not from having memorized the questions.
Rather, the repetition stimulated recollection of events, medications, previous test results and prior cardiac episodes my father had experienced before.
It took four tries, but, eventually, a true picture emerged of Daddy’s medical history.
History, also known as anamnesis, is our topic for today.
Anamnesis came to Latin from the Greek ananamimneskesthai. meaning “to remember.” It is the source of our word, amnesia, which also came to Latin from Greek and literally means “forgetfulness,” although it is mostly used in a medical sense to mean loss of memory after physical or psychological trauma.
In medical terms Dorland’s Illustrated Medical Dictionary defines anamnesis as “the collected data concerning a patient, his family, previous environment, and experiences, including any abnormal sensations, moods or acts observed by the patient himself or by others, with the dates of their appearances and duration as well as any results of treatment.
In veterinary practice we are unable to obtain history from our patient, so we depend on owners’ or caretakers’ observations to tell us what has happened with the pet prior to its presentation for care.
History can be extremely valuable.
Or it can be misleading.
A subtle clue in the history may spark an index of suspicion, a trigger to cause us to think of a certain body part or organ system.
Duration, whether a problem has been present for a few minutes, a few hours, days, weeks or months also helps us to categorize an ailment.
Studies have shown that 80% or more of diagnoses in general medicine clinics (physicians) are made on history alone.
History is not only important during office visits for illness and injury, but also in well-patient visits. Just because a patient is presented for a wellness check doesn’t mean he is well. We often see the “while he’s here” syndrome, such as, “Fluffy is here for examination and vaccinations but while he’s here could you look at his swollen ear? And, he’s been limping on his right rear leg for about three months.”
Problems arising on well-patient visits can be more subtle. such as “Roger can’t seem to jump up onto the couch like he used to, but we don’t think that’s important. It’s just because he’s old.”
However, age alone doesn’t cause problems. Body changes secondary to aging can lead to abnormalities that are perceived as aging problems. If Roger can’t jump like he used to, we need to know if he has pain and/or degeneration underlying the symptom. An accurate diagnosis allows us to proceed to accurate, effective treatment.
History taken prior to the examination alerts the clinician and makes him better prepared to examine body parts that may be participating in the dysfunction.
So, the next time you take your pet to a veterinarian be prepared with honest, accurate answers to the history questions. Those answers can make a huge difference in your pet’s quality of life.
See you next week, Dr. Randolph.