How to take a negative medical history?

From the Guidelines

Taking a negative medical history involves systematically asking patients about symptoms, conditions, or risk factors they do not have, which helps rule out potential diagnoses. Begin by explaining to the patient that you'll be asking about symptoms they may not be experiencing to get a complete picture of their health. Use direct, closed-ended questions such as "Have you experienced chest pain?" and document negative responses clearly. Cover all relevant body systems methodically, including cardiovascular, respiratory, gastrointestinal, neurological, musculoskeletal, and others based on the presenting complaint, as outlined in guidelines for managing persons infected with HIV, which emphasize the importance of a thorough medical history, including past diagnoses, medications, and comorbidities 1.

When taking a negative medical history, it's essential to ask about the absence of associated symptoms that typically accompany the main complaint. For example, if a patient has abdominal pain, ask if they do not have fever, vomiting, or changes in bowel habits. Inquire about the absence of medication allergies, family history of relevant conditions, and social history factors like smoking or alcohol use, as these can impact treatment and management, as noted in the 2009 update by the HIV Medicine Association of the Infectious Diseases Society of America 1.

Some key areas to cover in a negative medical history include:

• Absence of HIV-related conditions, such as opportunistic infections or malignancies
• No history of antiretroviral therapy or other medications that may impact current treatment
• No comorbidities, such as coronary heart disease, dyslipidemia, or diabetes mellitus
• No psychiatric history, including treatment for depression, anxiety, or suicidal ideation
• No history of sexually transmitted diseases or other infections
• Up-to-date immunization history and healthcare maintenance, including last eye exam, dental visit, and screening tests for latent tuberculosis, as recommended in the 2014 guidelines for the management of persons infected with HIV 1.

Document all negative findings using clear terminology such as "denies," "no," or "absent." This approach is valuable because negative findings help narrow differential diagnoses and prevent unnecessary testing. Additionally, establishing what symptoms are not present can be just as diagnostically useful as identifying those that are, allowing for more focused and efficient patient care.

From the Research

Taking a Negative Medical History

To take a negative medical history, it is essential to understand the process of gathering relevant information from patients. According to 2, preparing the environment, communication skills, and the importance of order are crucial in taking a comprehensive history.

• A significant proportion of diagnoses are made based on history taking, often alongside physical assessments and laboratory investigations 3.
• History taking is a structured but flexible process of gathering relevant information from patients to inform diagnosis and treatment 3.
• Important communication skills for nurses when history taking include active listening, empathetic communication, and cultural sensitivity 3.

Challenges in Taking a Negative Medical History

There are several challenges in taking a negative medical history, including:

• Patients may provide an unreliable history of past experiences due to errors in comprehension, recall, evaluation, and expression 4.
• The way questions are composed may have a significant effect on the received answers, with closed-ended questions usually resulting in positive responses and open-ended questions resulting in negative responses 5.
• Patients may understand up-front agenda-setting questions in ways that hamper their effectiveness, biasing answers away from "non-new problems" 6.

Best Practices

To overcome these challenges, it is essential to:

• Be aware of the specific human fallibilities that can lead to errors in history taking 4.
• Use open-ended questions to gather more accurate information 5.
• Engage patients in a conversation about their health issues to facilitate their participation and autonomy 3.
• Use a step-by-step process for taking a comprehensive patient history, as outlined in 3.