It is not essential that you have a detailed knowledge of
modern examining and testing procedures. But some awareness of the basic, long-established
methods and tests and the newest x-ray and laboratory tools, and what they can
do, will be useful.
THE CASE HISTORY
The patient's history, always an invaluable guide in disease
diagnosis, is equally valuable in prevention. We have mentioned earlier, in
passing, some of the reasons. Occupational data-facts about the work you do and
possibly the circumstances under which you do it-may reveal some hazards,
physical or psychological, to which you are exposed. An account of family health-the
illnesses of parents and grandparents, their longevity, the state of health of
brothers and sisters-can provide clues to hereditary strengths and weaknesses.
Your own past illnesses are 'an. important part of the
record. Some childhood episodes of illness, if severe, may have left a mark.
Rheumatic fever, for example, may strike a child at 15 or earlier and may
produce some heart damage. Yet, very often, the effects of the heart damage are
not felt until age 35, 40, or even later. A record of the rheumatic fever incident
may be of vital importance in accurate diagnosis of a heart condition.
The case history-which includes what the patient reports
about present problems-sometimes, provides the first indication of onset of a
serious illness. For example, angina pectoris (chest pain) is associated with
coronary heart disease. In coronary heart disease, the coronary arteries
feeding the heart muscle become narrowed. There are sophisticated techniques
now-including x-ray movies of the coronary arteries -to show up the narrowing.
But in some early cases, angina may occur before there are sufficient changes
to show up on the x-ray studies.
If in taking the history the physician determines that there
have been angina episodes-perhaps after some sudden unusual exertion, perhaps
upon leaving the house on a particularly cold morning-he can confirm the anginadiagnosis by giving the patient some nitroglycerin tablets to take when the
next incident occurs; and if there is immediate relief of pain, the diagnosis
is virtually 99.9 percent certain. During history taking, be accurate, don't
make wild guesses, but do report things you may think are only minor, like a
sense of just not feeling well. It's important to indicate any change because
it may be an early warning of something potentially serious.
