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It’s all in the history (a continuing story)
  1. Paul Morrish
  1. Correspondence to Dr Paul Morrish, Consultant Neurologist, Department of Neurology, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN, UK; paul.morrish{at}glos.nhs.uk

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The most practical of neurologists know the value of listening to the history both in making a diagnosis and in managing the patient’s symptoms.1 2 3 Over the course of a career we hear more and more histories and a large part of our accumulating expertise is getting better at recognising the things that people say, and the importance of how they say it. Listening to the stories and the way they are interpreted forms part of the interest in the job, and many doctors have described the privilege they feel at being allowed, so intimately, into a patient’s thoughts and fears.

The way that a history is given depends on things within and outside the patient. It is influenced by their background, their social class, their culture and their education. It depends on the time and the place in which they are living. Their understanding and interpretation of their own symptoms is determined by their and their friends' and family’s previous experience and knowledge of the symptoms. It depends on their access to the internet, the tabloids and the broadsheets, the men’s health and the women’s health magazines, and television. They then may have rehearsed their outpatient visit many times over, in their minds and with their friends. How they understand and interpret the symptoms, in part, determines how they tell you, the doctor, about them. It also depends on how they perceive you and your role (“what do you want to know that for? my doctor only sent me here for a scan”). We’ve also recently learned that it’s not so much what they say as the way they say it.4

But how to teach students to be sensitive to all of these things? Most students who come to neurology are keener to learn the intricacies …

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