Departments of Psychiatry and Addiction Medicine, Southern California Permanente Medical Group, Laguna Hills, CA.
Perm J. 2020;24. doi: 10.7812/TPP/19.186.
One of the axioms of medical practice is that obtaining a good history is key to making a correct diagnosis and developing a treatment plan. This is particularly true in psychiatry, in which laboratory or imaging investigations are not typically of great value. Any factor that compromises a history may compromise care. This area of practice has not been formally studied, although it is widely believed to be true. In mental health settings, there are many factors that affect obtaining the history. Among these are the skills of the clinician in eliciting relevant information in a limited time, the clinician's philosophy regarding the importance of such history, and lack of formal training in history-taking. Nonphysician clinicians may be more likely than psychiatrists to confront these barriers. Practice settings may, in their effort to maximize access, patient turnover, and cost control, convey a here-and-now approach to patient care, implicitly downplaying the importance of a complete history. There may be some cultural factors at play as well, reflecting American society's gradually decreased interest in the study of history. Despite these understandable barriers, the need for a complete history is still the highest priority in an initial evaluation. Some suggestions are offered to support clinicians' and organizations' struggles to keep a comprehensive history at the forefront of care.
医学实践的基本原则之一是，获取详细病史对于做出正确诊断和制定治疗方案至关重要。这在精神病学中尤为如此，因为实验室或影像学检查通常没有太大价值。任何影响病史采集的因素都可能影响治疗。尽管这是公认的事实，但该实践领域尚未经过正式研究。在精神卫生机构中，有许多因素会影响病史采集。其中包括临床医生在有限时间内获取相关信息的技能、医生对该病史重要性的看法，以及缺乏系统的病史采集培训。非医师临床医生比精神科医生更有可能面临这些障碍。医疗机构可能会为了最大限度地提高可及性、患者周转率和成本控制，传达一种即时治疗的方法，从而含蓄地淡化完整病史的重要性。可能也存在一些文化因素在起作用，反映了美国社会对历史研究兴趣的逐渐下降。尽管存在这些可以理解的障碍，但在初始评估中，仍需要将完整病史作为最高优先级。文中还提出了一些建议，以支持临床医生和医疗机构努力将全面的病史置于治疗的首要位置。
