Chapter 3: Health History - Detailed Summary
Introduction
The health history is a structured framework for organizing the patient’s
narrative into comprehensive categories. This framework enhances clinical
reasoning and ensures a thorough approach to patient care.
Different Kinds of Health Histories
1. Comprehensive History: Used for new patients to create a detailed
understanding of their health.
2. Focused or Problem-Oriented History: Tailored to address specific
concerns or ongoing issues.
3. Health Maintenance Visits: Focused on preventive care, such as
screening tests and counseling.
Scope of Assessment: Comprehensive vs. Focused
Comprehensive Assessment: Ideal for new patients; includes all
components of health history and physical examination.
Focused Assessment: For established patients or those with urgent
concerns; targets specific issues.
Subjective vs. Objective Data
Subjective Data: Information provided by the patient (e.g.,
symptoms, perceptions).
Objective Data: Findings from physical exams and diagnostic tests.
Components of the Comprehensive Adult Health History
1. Initial Information:
oDate and time of history.
oIdentifying data (e.g., age, gender).
