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Xiao-Rong
DIAGNOSTIC CLUES
IN
GENERAL
PEDIATRIC
PRACTICE
Many physicians are convinced
that
the
history of
complaint yields clues
to successful diagnosis and manage-
ment in
up
to 90 percent of encounters
with adult
patients.
ln
a
general pediatric
practice,
however,
there are substan-
tial differences
in
the
encounter, which
bear
examination
and analysis. The
fea-
tures
in
common with the history-tak-
ing encounter in adults
is
that the proc-
ess is essentially one of gathering evi-
dence; the process precedes the physF
cal examination, and data are recorded
according to a prescribed format. The
important differences
are
that the
his-
tory (except
in
the case of
an
adoles-
cent patient)
is
related by an intermedi-
ary, the
parent;
that the identified
pa-
tient, the child, is not always the
real
patient; and
that the
identified
promblem
is
often
not
the
real
problem.
Another essential difference
is
that
the
traditional history-taking process
and
the traditional physical examination are
blurred
in
the pediatric interview. Ob-
servation of the
child and
mother, or
family, begins while they are
in
the
wait-
ing room, in passage to the examining
room, and during the conduct
of
the
in-
terview. The relationship
between
the
mother
and child,
their
reaction to
stress
or separation, the developmental sta-
tus
of
the
child,
the
appearance of
the
child,
the
relationship between the par-
ents, the state of dress and hygiene,
the ethnic origin and social class, the
appropriateness of discipline and
ex-
pectations, the warmth of support, and
a host of other observations are made
prior to the
first introduction.
ln subse-
quent paragraphs this
will
be
treated
more fully.
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