Taking a Patient History, Article Critique Example

Introduction

The article “A guide to taking a patient’s history” by Lloyd and Craig (2007) in the journal Nursing Standard, presents an outline of the process of taking a patient history. The process as described by Lloyd and Craig includes key aspects of establishing an appropriate environment, using correct communication skills, and taking the history in an appropriate order. The article additionally explains the importance behind taking an accurate patient history. This critique of the Lloyd and Craig journal article first summarizes the content of the article, then provides a critique of it.

Summary of Article

Lloyd and Craig (2007) offers an explanation for why the patient history is such a critically important part of assessing a patient. This is the patient’s opportunity to describe the problems they are having as well as previous problems they have experienced, and in so doing provide the healthcare provider with essential information. Increasingly, the task of taking the patient history is delegated to nurses, nurse practitioners, or nurse specialists. The purpose of this article is to provide a framework for taking such patient histories.

Lloyd and Craig (2007) suggest three keys to taking a comprehensive patient history include establishing an appropriate environment in which to take the history, using excellent communication skills, and taking the history in an appropriate order. In terms of the environment, Lloyd and Craig suggest that the elements that make the environment appropriate are that it be accessible, equipped properly, free from distractions as much as possible, and a safe place for both the patient and the nurse (Lloyd & Craig, 2007). One vital element is also that the patient, and his or her beliefs, be treated with respect. This includes, for example, staying non-judgmental, and providing a private place with no interruptions. This may not be possible in the cases of emergency situations, but all efforts to maintain patient confidentiality should be taken. Finally, the nurse needs to allow enough time to take a complete history.

Lloyd and Craig (2007) also note the essential aspect of using good communications skills to allow the patient to explain the problem in their own words. Establishing a rapport, showing interest, and using direct words instead of jargon are part of this skill set. Nonverbal communication skills include such specifics as eye contact, nodding to encourage the patient to continue, and showing appropriate hand and facial responses and gestures. Of course, the first part of such a patient history is to gather informed consent. This means that the patient must be capable of providing such consent.

Lloyd and Craig (2007) explain that the patient history is most effective when taken in an organized fashion starting with an introduction that explains what the nurse is doing, followed by obtaining consent. Then the specific problem or issue that is causing this visit should be addressed. The next step is to identify prior medical problems and chronic conditions, followed by questions about mental health conditions. The patient should then be asked about any medications, whether prescription or over-the-counter. The next parts of the history include asking about family history (for familial conditions), social history (such issues as housing, alcohol and tobacco use, for example), and sexual history if this is appropriate. This is followed by asking about work history. The history ends with a set of systemic questions to make sure everything has been covered; this includes asking about major body systems not discussed elsewhere, such as respiratory or gastrointestinal system; these questions generally receive negative responses at this point, but if any positive answers are encountered, those issues should be probed for additional information. It may also be helpful to get additional information from the patient’s friend or relative, particularly if there is a loss of consciousness or cognitive problems.

In addition to these basics, Lloyd and Craig (2007) provide general guidelines for how to assess alcohol usage, a useful list of cardinal symptoms to ask about, and a discussion of the types of questions to ask and also to avoid in taking a history. This paper’s discussion of taking patient histories is not patient-specific, in that it could be applied to any adult or young adults, and, with some modification, with children old enough to describe their problems. The authors do point out that for those unable to answer comprehensive questions, it is appropriate to obtain the information from third parties such as parents or other relatives.

Critique of Article

Lloyd and Craig (2007) offered a comprehensive discussion of taking a patient history. Many things were done well in this article. Certainly, the discussion of what to include in a comprehensive patient critique seems both clear and very complete. In the discussion of how to ask questions, however, the differentiation between closed questions and clarification seemed a little too specific. Also, the communication skills described seem unnecessarily complex. This may be due to a need on the part of the authors to be complete, but for a new nurse, trying to recall everything in this article would seem to be a very difficult task. The authors do note that it takes time to develop good history-taking skills, so new nurses would benefit from reading it.

Another point was that the nurse was described as needing to allow enough time to do a complete patient history, yet to do the process as described in Lloyd and Craig (2007) would require quite a lot of time for any patient with a significant medical history or chronic conditions. Lloyd and Craig are based in Britain, with its National Health Service, instead of in the U.S. with its third-party payer medical coverage, and where many patients have no coverage at all. Many of these questions may be better answered via accessing a patient’s medical records. However, on many occasions medical records may not be available, such as in emergency situations, or in cases where the patient is new to a clinical practice.

Another issue is that many U.S. healthcare facilities take patient histories first by asking patients (or their companions/relatives) to fill out forms that ask the critical questions. In today’s healthcare environment, allowing time for nurses to take such a comprehensive history may be financially and practically unreasonable; this is, no doubt, why patients often fill out forms as the primary means of presenting their medical history. It is unclear whether the nurse’s time to take such a complete history would be compensated by medical payers in the U.S. A patient in pain or uncomfortable for any reason, seems unlikely to have the patience to answer the same questions verbally that they’ve just answered on a form. It would be interesting to have U.S. based senior nurse address this topic from the perspective of the U.S. healthcare environment.

Conclusion

Overall, Lloyd and Craig (2007) presented a helpful, useful article that described a way to take a comprehensive patient history. The keys to this skill are to establish an appropriate environment, to use excellent and effective communication skills, and to take the history in an organized fashion. Taking a proper patient history is a vitally important aspect of health care because it forms the core of the patient assessment and offers the patient a forum to describe their problems and offer supporting information to guide the practitioner’s understanding of the issue at hand. The description of the patient history presented by Lloyd and Craig (2007) offers extremely useful guidance for understanding the skill of taking patient histories. It also explains that being incomplete in such histories can lead to incomplete information which may ultimately lead to less than ideal patient outcomes.

References

Lloyd, H. & Craig, S. (2007). A guide to taking a patient’s history. Nursing Standard, 22 (13), 42-48.