History of Current Illness as Treatment
Experienced clinicians report that taking a good history of present illness can be therapeuticit not only helps the patient to feel better, but to heal better. The process of obtaining an accurate database includes establishing an interpersonal engagement, which may be described as a negotiation of compatibility. This negotiation includes several quantities sought by the patient from the clinician: 1) safetyassurance that patients will not regret what they have said, either because of hurt to themselves or the listener (e.g., the patient risks feeling embarrassed by their infirmity, or that the severity or distastefulness of their malady will be disturbing to the clinician); 2) sensitivityempathetic listeners evoke open disclosure; a clinician who lacks empathy for health concerns like obesity will not likely receive the complete candid communication of the patient; 3) affective competencefor example, when the patient is experiencing emotional overload, the clinician’s response acknowledging the burden, validating the appropriateness of the patient’s feelings, and yet maintaining a confidence-building effect, helps the patient to build their own confidence: Patients, indeed, incorporate their clinician’s health optimism into their own perception of illness and health; 4) cognitive competencethe expectation by the patient that the clinician will have sufficient intellectual acumen to accurately assess and manage the problem presented.
As the patient’s story is being shared with the clinician, it is being re-experienced by the patient through the clinician’s responses. Messages of empathy and positive regard during this process, when shared with dispassionate equanimity, may be adopted by the patient as their own. On the other hand, critical, non-empathetic, devaluation responses might also be assimilated by the patient, increasing suffering and conflict.
A properly conducted history produces maximum relief in the patient and maximum personal and professional satisfaction in the clinician.
Adler H. J Am Board Fam Pract 1997; 10:28-35.
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