Gillis Jonathan
Children's Hospital, Westmead, Sydney, Australia.
Bull Hist Med. 2006 Fall;80(3):490-512. doi: 10.1353/bhm.2006.0097.
For the ordinary doctor the taking of a medical patient history is and has been one of the fundamental procedures. This article looks at instructions on the taking of a history in medical texts, to delineate what happened to the position of the patient history in clinical assessment with the increased emphasis on physical examination that began around the middle of the nineteenth century. The analysis reveals that the taking of a history remained important, with a consistent approach from 1850 to the end of the twentieth century. The patient history became incorporated into the physician's examination as another set of observations and signs, thus producing two histories: a superficial, chaotic story presented by the patient, and a deep, "true" history revealed by the skill of the physician. Within pediatrics, the primacy of the physical examination appears to have been asserted well before the introduction of history-taking.
对于普通医生而言，采集患者病史一直是一项基本程序。本文审视医学文本中关于病史采集的说明，以描绘在19世纪中叶左右开始日益强调体格检查的情况下，患者病史在临床评估中的地位发生了怎样的变化。分析表明，病史采集依然重要，从1850年到20世纪末都保持着一致的方法。患者病史被纳入医生的检查之中，成为另一组观察结果和体征，从而产生了两种病史：一种是患者讲述的表面的、杂乱的情况，另一种是医生凭借专业技能揭示的深入的“真实”病史。在儿科学领域，体格检查的首要地位在引入病史采集之前似乎就已确立。
