Respiratory disease complaints and history of current illness

The core points of the current history of respiratory disease complaints are essentially anchored in the five core elements of "core respiratory symptoms + accurate timeline + triggers/exacerbation and relief characteristics + accompanying manifestations + related exposures/past medical history". By minimizing vague descriptions such as "uncomfortable" and "long time", it can provide more than 80% of effective information for the first clinical diagnosis, greatly reducing the probability of missed diagnosis and misdiagnosis.

When I was doing my emergency room rotation in the middle of the night last week, I met a 28-year-old programmer. He came in, slumped in the chair and shouted, "Doctor, I have a cold that makes me sick. Give me antibiotics quickly." I didn't rush for a check-up, but after asking a few questions, I found something wrong: the "suffering from cold" he mentioned was actually a severe dry cough every night for three consecutive days when I lay down on my back. The cough made my chest hurt, and I couldn't even sleep the whole night. There were no typical symptoms of upper respiratory tract infection such as nasal congestion and runny nose. Last week, I went to a closed party hall during the team building, and two friends around me have already been tested positive for mycoplasma. Just a few words of effective information were much more useful than the "cold" he called at the beginning. The follow-up test for Mycoplasma pneumoniae antibodies turned out to be positive, and he was prescribed oral medication. Within a week, he came back for a follow-up visit and said he was basically cured.

When it comes to respiratory clinical clinical collection history, there have always been two different practice habits. No one is right or wrong, it is more like a path dependence accumulated from different experiences. Most of the older generation of professors put "symptoms first" and sit down to dig into the minutiae of symptoms first: Is the cough worse during the day or at night? Is the phlegm clear, yellow or blood-streaked? Does your cough get worse when you smell oil smoke or cold air? When you wheeze, is there a whistling sound in your throat or is it like a stone is pressing on your chest and you can't breathe? These details can often narrow the differential diagnosis down to single digits. The younger generation, or doctors with a background in infectious diseases, prefer "exposure priority". First, ask whether you have been to a densely populated closed place recently, whether you have been in contact with patients with fever and cough, whether you have pets at home, whether they have been renovated recently, and whether you have been exposed to pollen and weeds in the suburbs. I met a junior high school girl before who had been coughing for half a month and had taken various cold medicines and antibiotics to no avail. Finally, I found out that she was on duty last week and went through the school's old bookshelf that had been piled up for several years. She found out that it was an allergic cough caused by mold allergy. She didn't even prescribe antibiotics. She was fined after a week of inhaled hormones.

Many patients think that the more they talk about their medical history, the better, but this is not the case. Fragmentary thoughts that fail to grasp the key points can easily bury key information. Last month, an aunt came to see a doctor. She sat down and chatted for 10 minutes about how naughty her grandson was and how tiring it was to take care of the baby. Finally, she mentioned casually, "I just recently took my baby to the park and I kept coughing, and occasionally the phlegm was stained with red blood." Thanks to my careful questioning, I found out that she had a chronic problem with bronchiectasis. She touched catkins all over the street in the park that day and coughed up a small blood vessel due to the irritation. If we had followed her initial comment about "tiredness of raising a baby", we might have missed the point.

There is another pitfall that everyone easily steps into: don’t diagnose yourself first. Many patients say, "I have a chronic illness" or "I must have the flu" as soon as they come in. Instead, they hide the real symptoms in their own preconceptions. Last month, there was an old man who came in and said that he had a recurrence of chronic bronchitis and needed to be prescribed anti-inflammatory drugs. I felt the edema in his lower limbs, and after asking a few more questions, I found out that besides wheezing, he couldn't lie down at night. Finally, it was found that the wheezing was caused by heart failure, and it was not a primary problem of the respiratory tract at all. If he came later, something serious might happen.

In fact, you don’t need to memorize any templates. It doesn’t matter if you don’t know clearly when you get to the hospital. Just follow the doctor’s questions and answers. You can take out the temperature records you measured before, the leftover pill boxes, and even the photos of sputum you took. These are all the most practical references. After all, when it comes to medical treatment, the more accurate the information between doctors and patients is, the less you will suffer and the less detours the doctor will make.