GATHERING INFORMATION

GATHERING INFORMATION

The experienced clinician will recognise the acuity and sever ity of the patient’s condition even before a history has been taken. Initial observation provides clues to the direction that the history should take: general appearance, gait, position in bed, facial expression and tone of speech all provide useful hints. In an acute presentation, it is important to realise that Sir William Osler , 1849–1919, Canadian Physician, initiated bedside clinical training for medical students at Johns Hopkins School of Medicine, Baltimore, MD, USA. ‘Listen to the patient; he is giving you the diagnosis’. the patient will feel anxious and vulnerable and may well be in severe pain; therefore, clinicians should introduce themselves, - try to comfort the patient and gain the patient’s confidence. Clinicians should put the patient at ease and seek permission to begin the consultation in ensured privacy . If a patient is still uncomfortable or reticent, the presence of a close family member as a chaperone can help. A tense patient without a m relaxed abdominal wall will substantively a ff ect the accuracy of the clinical examination. This is particularly important in a busy emergency department where the patient is only one - among many . Summary box 63.1 - Importance of history and examination /uni25CF /uni25CF -

To understand: The pathophysiological basis of common abdominal • symptoms and signs as the pathway to clinical diagnosis To be aware of: Leading questions and relevant physical signs based on • the organ or system affected There is no substitute for a detailed history and thorough clinical examination The temptation to proceed to a diagnostic investigation such as abdominal ultrasound or computed tomography scan without clinical examination should be resisted