Complaints of the patient

With the question of complaints begins a conversation with the patient. It is advisable to give the patient himself an opportunity to speak on this matter in a form convenient for him. However, often due to lack of attention to their health or due to other circumstances, the patient does not name all the painful feelings. Therefore, the doctor clarifies complaints with additional questions.

Among the complaints it is desirable to immediately identify the main, or basic, and secondary, or additional. However, the importance of a complaint is often difficult to determine. Sometimes unpleasant feelings of the patient, even expressed very sharply, emotionally colored, do not have a direct relationship to the underlying disease.

However, in typical cases, the main complaints with detailed specification can be of decisive diagnostic value.

A special place among complaints is usually occupied by pain. It should be clarified as follows:

1. localization of pain;
2. possible paroxysmal nature and duration of the attack;
3. time of occurrence and a possible cause, including bearing in mind the functional load on the allegedly painful organ;
4. intensity;
5. factors that enhance and relieve pain;
6. irradiation - the spread of pain.

Particular importance is the relationship of pain to the functional load on a particular organ. So, with regard to chest pain ( angina pectoris ) or in the heart (cardialgia) it is important to establish a provoking effect of physical activity and a rapid decrease in rest and after taking nitroglycerin, which confirms the stenocardic nature of the pain. With pain in the epigastric region (suspicion of peptic ulcer disease ), their relationship with food intake is specified, ie, appearance after 0.5 or 1.5-2 hours after eating (at the height of digestion) or on an empty stomach and decrease after eating.

The clarification of the main complaint is accompanied by questions about other unpleasant sensations in the field of the same or other organs and systems.

You should always ask about common manifestations of the disease: general weakness, fever, chills, headaches, irritability, appetite disorders, thirst, weight loss, etc.

At the same time with. By revealing of complaints the doctor tries to estimate features of the patient's personality, his state of mind, the probability of exaggeration or understatement of complaints. The patient's reaction to the painful manifestations reported to him is also specified - the elements of the internal picture of the disease.

Significantly fewer patients at the time of examination do not complain, feeling healthy. To the doctor, they may be caused by a discoloration of the skin discovered by others, for example jaundice; revealed during a dispensary or "accidental" examination of changes in the lungs on the roentgenogram; the appearance of protein or sugar in the urine.

Assessing complaints, the doctor constantly analyzes them, makes sense, which contributes to the emergence of specific assumptions about the nature of the disease. Further study of the anamnesis and objective research provide additional important information that confirms these assumptions or leads to new conclusions.

[1], [2], [3], [4], [5]