Wednesday, February 20, 2008

History as a medical tool

The February 16, 2008, issue of The Lancet contains an article by Howard I. Kushner on "History as a medical tool," in which the author uses two real life examples to illustrate the value of history as a clinical tool.

In the clinical setting, the word "history" is most often used to refer to the patient's own health history; "Medical History Taking" is the official medical subject heading for the process of obtaining information from the patient in order to formulate a diagnosis. Kushner advocates a different perspective, investigating the history of a disease to better understand its causes and symptoms.

Using the examples of Tourette's syndrome and Kawasaki's disease, Kushner shows how knowledge about the development of the definition of a syndrome or disease can greatly influence clinicians' understanding of the nature of that disease and hence their diagnosis of the disease in patients displaying some or all of the hallmark signs. Re-examination of case studies, written descriptions, and theories of disease epidemiology can help doctors to question old assumptions and may lead to new pathways for research. Or, in Kushner's formulation: "historical interrogations of syndrome construction can elicit useful issues for the development of research hypotheses and novel approaches to medical conundrums."

So get out there and start interrogating!

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