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
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