History-taking and clinical examination

The ability to appreciate an unusual comment or minor abnormality can lead people to the correct diagnosis. General malaise and debility, breathlessness, cyanosis and difficulty with particular movements or an abnormal gait are much more obvious during exercise. The full history of the main complaint or complaints must be recorded in detail, with precise dates. It is important to get right back to the beginning of the problem. When a patient complains of indigestion, for example, it is sensible, after recording the history of the indigestion, to move on at this point to other questions about the alimentary system. Patients are rarely able to make useful guesses at the amount of blood vomited up, and the addition of gastric juice makes questions on the volume of blood vomited of little value. Cardiac pain typically begins in the midline behind the sternum, but may occasionally be experienced in the epigastrium.