History -

The gold standard.

History taking has been described beautifully in countless medical textbooks, each offering its own perspective. One of the fascinating aspects of medicine is that our understanding deepens when we explore these different viewpoints and interpretations.

History taking, clinical examination, and appropriate investigations form the foundation of any clinical assessment. Their collective purpose — or if you prefer, their aims and objectives — is to guide us toward an accurate diagnosis so that we can provide the most appropriate care.

History taking is not a static skill. It evolves throughout our careers, shaped by experience, reflection, and the countless patients and families we encounter. In paediatrics, this process becomes even more nuanced. We care for individuals ranging from extremely preterm infants to adolescents approaching adulthood. Communication styles vary, developmental stages differ, and parents or carers often serve as the primary historians. Each encounter demands adaptability, sensitivity, and clinical curiosity.

Most of us were introduced to history taking through a familiar framework:

• Presenting complaint

• History of presenting complaint

• Past medical history

• Birth and neonatal history

• Developmental history

• Family and social history

This structure remains invaluable. It ensures completeness, supports systematic thinking, and forms the backbone of OSCEs, written exams, and clinical documentation. Yet, in today’s world of MCQs, short‑answer formats, and algorithm‑driven tools, it can be tempting to view this approach as old‑fashioned.

Believe it or not- It remains the gold standard for delivering safe, thoughtful, patient‑centred care.

The Art Behind the Structure

What is often overlooked is that history taking is not merely the act of recording information. It is an interpretive process.

Yes, we must document the narrative in the parent’s or patient’s own words. That is essential for accuracy and avoids bias for other clinicians. But important aspect is analysing the history to help us to arrive at a diagnosis or at least understand the problem for further evaluation.

Listening is fundamental, but clinicians should not be passive scribes. We should guide the conversation, ask clarifying questions, and explore symptoms with purpose. We synthesise information, identify patterns, and begin forming a differential diagnosis before the examination begins.

This interpretive element is rarely emphasised in textbooks, yet it is central to effective clinical practice.

Always have an unbiased and open mind approach.

Many teaching resources advise clinicians to “always read the referral letter first.” While referral letters can provide helpful context, they also carry the risk of anchoring bias. Approaching a case with preconceived ideas can subtly influence the questions we ask and the conclusions we draw.

For students and trainees especially, try not to know about diagnosis or problem before approaching. Beginning with an unbiased, fresh perspective is invaluable. It allows the clinician to form an independent impression before integrating external information. We should always challenge ourselves.

Listening and Guiding the History-

One of the most important aspects of communication in paediatrics is listening. We must listen carefully to parents and patients. However, it is equally important to recognise that history should be guided by us. Parents and patients may understandably become focused on particular concerns, some of which may not be clinically relevant. Our role is to gently guide the conversation so that we obtain the information that is most relevant to the child’s current problem, while still acknowledging parental concerns.

Parents are Aways Right (until proved otherwise)-

As we often say in paediatrics, parents are always right unless proven otherwise. Their observations and concerns should be taken seriously, as they know their child best and often provide crucial information that guides diagnosis and management.

Observation

This is more often mentioned with assessment during examination. I strongly believe that observation is most important aspect of history taking starting right at the beginning.

First and foremost thing to ask ourselves-

•Does this child look well or unwell?

•Does the child require immediate medical attention?

•If there is any concern, SHOUT for help immediately. Acting promptly may save a life.
Not only this but keen observation can give us important clues to our lead for questions to parents/patients and even to diagnosis. Some of the things we can notice are-

•Cyanosis

•Respiratory distress

•Pallor

•Rashes

•External bleeding

•Congenital abnormalities or syndromic features

•Weakness, abnormal gait, or visible neurological signs such as nystagmus or tremors.

For those in training suggestion would be on the units and wards, look for opportunities to take history and examination. Offer help to resident doctors. Form a team to discuss and share. We are lucky now to have information in the hands but our best teacher will always be our patients.

Please do not forget to share your views.