Why now? - why patients present

Psychological and social as well as physical factors influence the decision to consult, including:

• the perceived threat - eg fear of cancer or heart disease
• age - parents present a child with symptoms which they would not report in themselves
• social class - upper and middle class patients are more likely to present for any given symptom or sign
• ethnicity - Asians present more often than non-Asians; Jews and Italians consult disproportionately often
• education and medical knowledge - anatomy, significance of symptoms, what constitutes good health or normality
• onset - an acute rather than gradual onset of symptoms
• symptoms which interfere with social activity
• symptoms with greater frequency or persistence
• bizarre symptoms or symptoms differing from others
• visible signs
• failure of selfmedication - ask what's been tried
• pressure from relatives, friends or work colleagues
• need for certification
• being elderly, female, divorced/separated or lonely
• similar symptoms previously required health care
• a good doctor-patient relationship (not too friendly!)
• an unrelated personal crisis or stress