History Taking & Clinical Examination : Its Importance
In the present day medicine, detailed history taking and methodical clinical examination, a sine qua non for diagnosis and treatment, appears to have lost its importance. Cursory examination by the juniors, rarely by the seniors, if they have time has become the routine. Vital information needing a questioning mind, vigilant eyes and prehensile hands are thereby missed.
Our people are God fearing. For good results the doctor gets the credit and whenever bad, God is blamed. Fortunately they are not legal minded otherwise things might have been different. Three cases are presented as an eye opener :
1) One Mr X 45 years old reported to OPD JIMCH (Jahurul Islam Medical College Hospital) with swelling of left knee and occasional locking for one year. He had a history of Assault about ll/2 year back - injury to his knee by a bamboo spike. He was initially treated locally, possibly with antibiotics. Then he went to a Premier Medical College Hospital of Bangladesh. He was diagnosed as Traumatic Synovitis and Synovectomy was done.
On Examination by us : Operation scar in front of the knee was present. There was swelling of the knee with effusion and synovial thickening. Occasional creps also noted. While examining he said that sometimes his knee got stuck during movement and sudden jerk relieved it. He felt something moving inside. This arose a suspicion of loose body inside the joint. X-ray showed erosion of the articular surface of the femur. Immediately the joint was opened, fluid gushed forth and a funny looking dark object was visible. It was taken out - a conical piece of bamboo 21/2 long, 3/4" diameter at it's base. The wound after thorough toilet was closed. It healed with primary intention and the patient never returned after that.