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toid arthritis, colon/breast cancer) or single gene disorder (e.g. familial
hypercholesterolemia, sickle cell anaemia, cystic fibrosis). Secondly,
the patient’s concerns about his/her presenting complaint may be re-
lated to the experience of other family members (someone in the fami-
ly had similar symptoms and was diagnosed with cancer, for exam-
ple). It is equally important to explain the significance of taking a
family history by asking
Is there a family history of …?
Social history
. The aim of this section is to establish a picture of
the patient as a human being, and as such it is essential to the patient-
centered approach. Social history is an umbrella term that includes the
patient’s family life, their occupation, their environment (where they
live and the conditions in which they live), their financial situation,
their level of education, and their lifestyle 9tobacco, alcohol and rec-
reational drug consumption; general fitness; rest and relaxation – holi-
days, sleep patterns, hobbies, etc.; and sexual practices). All of these
factors have a potential bearing on the presenting complaint. Financial
worries are renowned for causing stress, which could manifest itself in
any number of ways (tension, depression, irritable bowel syndrome,
etc.), while the level of education could give an indication as to the
patient’s perceived access/right to medical care.
It is important for a doctor to be able to look beyond the appearance
of their patient and avoid the possible assumptions that we all tend to
make – a human failing from which doctors are not exempt. On the one
hand doctors are told to avoid stereotyping while at the same time they
are required to take note of their patient’s appearance and read the clues.
General appearance could give clues or indeed mask clues to the pa-
tient’s well-being; for example, someone who is well-dressed and appar-
ently without physical signs may be suffering from depression, or may
have issues with alcohol, food, etc. The list is endless.
It is important during the consultation to give patients the chance
to express their own ideas and concerns about their problem and to de-
termine what their expectations are. The patient note is a record of
each encounter carried out by the patient’s GP and/or specialist. There
is a particular layout that should be adhered to for ease of access and
the content should clearly communicate the history and physical ex-
amination carried out on the patient, facilitating clinical reasoning and
conveying essential information to other consultants and healthcare
providers.