"Listen to the patient - he's telling you the diagnosis."
Even in hospital outpatient new cases, over 80% of diagnoses may be made on the history alone. In general practice, the proportion is considerably higher. Diagnostic conclusions should therefore be drawn from the history before embarking on the examination (and any investigations), which should be used to confirm or refute the history-based diagnosis.
History-taking must be suitably discriminating. Weight loss with increased appetite and dislike of hot weather are good discriminators for thyrotoxicosis but tiredness and irritability are not. Questions, like tests, are pointless if they are not likely to make a difference to the outcome.
Last reviewed 01/2018