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    6 views10 pages

    22

    Uploaded by

    Felipe Montorfano

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    © All Rights Reserved
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    LNG a ! TIE Tee LC 1 General Aspects of the Patient's Neurologic History Kenneth F. Swaiman and John Philips © Mressanded version ofthis chapter is avalableon wnt epezonsu com. Se ide cover for regia das When presented with a challenging patient in 1885, with, students Josef Babinski, Sigmund Freud, and others looking, ‘on, Dr. Charcot used the most important tools he had at his disposal: a careful history and a detailed examination. If he ‘were alive today, Dr. Charcot would use those same tools There is no substitute for an accurate and thorough history ‘The patient or parent begins with an explanation of his or her concern, In most medical settings this opening statement lasts, less than 60 seconds if not interrupted, as it unfortunately ‘generally is, by the physician (Beckman and Frankel, 1984). ‘More focused questions follow as a differential diagnosis i# developed. In some cases language can be a banter, particu: larly with the growing multiculturalism in the United States ang other countries, and it is importanc that the interview be ‘conducted in the native language of the patient. This may require the use of interpreters. Using a nonprofessional or poorly trained medical interpreter should be avoided because this has @ much higher risk of causing clinically significant fore than using an experienced professional interpreter (Flores e¢ al, 2012). In addition, an effective medical inter- view requires eye contact to help establish patient rapport (Cole and Bird, 2014), and the near-ubiguitous presence of ‘computers in examination rooms, with an electronic medical record at the physician's fingertips, can be a problem. Com- ppared with using paper medical records, there is now signifi- ‘antly more time spent looking at the medical record (now on, 4 computer screen) and less time looking at the patient (Asan, e

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