Thursday, April 19, 2012

The History of History Taking

One time I had an appointment with a client I had never met before. He brought in his two cats, a male and a female, for exams and vaccines. I noticed in their files that both cats had the same birthday. Wanting to know if the cats were related genetically, I asked “Are they littermates?” To which he replied, in all seriousness, “No, she uses the litterbox but he mostly goes outside.”

History taking is a vital part of the veterinary diagnostic approach, and can be just as useful, or, at times, more useful, than a physical exam. Often clients will have what we call a “presenting complaint”, which is the reason they made an appointment to see us. Sometimes the presenting complaint is indeed the most pressing concern for the animal that day; other times, we find something much more serious. I always start by taking a history and then doing a physical exam, leaving the presenting complaint for last, so we don’t miss anything.

Animals present with signs (vomiting, scratching, not eating, limping, etc.) not symptoms, as symptoms are self-reported (I have a toothache, my skin is very itchy, etc). It’s very important to hear from the owner what signs they are seeing at home. In nearly every exam, I ask about changes to bathroom habits, appetite, water consumption, and whether there has been any coughing, sneezing, or other signs of illness. Often when we begin to discuss what’s going on at home, we identify potential areas to be concerned about. Since my patients can’t say “I’ve been so thirsty lately”, it’s important for their owners to tell me “I have to fill Fluffy’s water bowl up several times a day”.

History taking is also important to help us narrow down which diseases are most likely. If a pet has traveled out of the area, I need to broaden my list of possibilities to include diseases we don’t commonly see here. I may also ask questions about lifestyle, such as whether a cat is strictly indoors, whether a dog spends much time socializing with other dogs, to assess risk for certain diseases.

So the next time you’re asked “Has Rex had any vomiting or diarrhea?” it’s not because I like asking that question every fifteen minutes, it’s an important tool to help me do my job.