How to Do Effectively History Taking: A Case Study of Gynecology System

Abstract

Taking a patient’s history is an initial step of health assessment in identifying the patient’s problem. Chief complaints, present illness, and past medical history are taken by Medical staff, nurses, and public health staff from patients or relatives. This article will describe the methods of taking present and past medical history from gynecological patient which seems to be the same as other patient. However, taking history from gynecologic patient is different from other patients because nurses receive information regarding contraception history, sexual history, and menstrual history which is the important data for diagnosis. In order to obtain details of the history, nurses should use important principles for taking history in gynecologic patients such as: performing in a comfortable and private setting; using open-ended questions; encouraging patients to describe their problems in a polite, friendly and decent manners. This article provides a good example of case study that help nursing students to analyze differential diagnosis by comparing and contrasting the possibility from patient history and findings