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Health History

"I was taught in medical school that 90% of any diagnosis is made from taking a good case history by talking to the patient. Or at least that is how medicine is supposed to be. The great shortcoming of “modern” medicine is not that doctors use too many drugs, but that they spend far too little time with their patients. You are lucky if you manage to get 15 minutes of your GP’s time, but 15 minutes hardly allow enough time to fully understand what has gone wrong. Never mind the time needed to integrate an understanding of three of four major problems.

Every major problem will have seven attributes:

  1. Onset – how did it start?

  2. Quality – how does it feel?

  3. Intensity – on a scale of 1-10, how intense is the sensation?

  4. Frequency – how often do you experience the problem?

  5. Duration – how long does an episode last?

  6. Concomitant Symptoms – do any other symptoms come with your main problems?

  7. Mitigating Factors or Therapies – have you tried anything that made it better? Worse?

If you can’t answer these seven questions about each problem, you do not understand the problem. And if you don’t understand your patient’s problems, you will never understand your patient". Dr. Culp 

Initial consultations with Dr. Culp last 2 hours, and follow-up consultations last 1 hour. Your health is considered from every possible angle, and every effort is made to look behind the symptom picture to possible underlying common causes.

Sometimes it is necessary to use laboratory testing to confirm or rule out a diagnosis, but laboratory testing should never be the primary basis for making a diagnosis, only the case history is adequately powerful and nuanced to do that. Without an accurate diagnosis, rational treatment is not possible. You can suppress symptoms but you can only cure a problem when you understand what is causing it. One of Hippocrates most important maxims was “tolle causum”, “find the cause”. Unless you know the true cause of an illness, the patient suffers, and both patient and physician are lost.