لخّصلي

The medical history is considered the cornerstone of safe and effective patient management. The starting point in the assessment and management of any patient depends on good history-taking. The main
parts of the history-taking process well known to practitioners are: "Presenting the current (existing) complaint", "the history of the current (existing) complaint" and "the current and past medical history".
Many patients are surprised to find out how important a medical history is for dental care. There are many interrelationships between general health and oral health; there are also many interactions of drugs that affect dental care. Below are some explanations of why we, as dentists, need to know about health conditions. Keep in mind, however, that this is by no means a complete list of health conditions or medications that affect dental care. Patients should always tell us about any medical treatments they are receiving and all medications they are taking.
The main parts of a patient history are well-established. It is important that practitioners follow a recognized systematic scheme of enquiry to minimize the risk of missing important information. All dental practitioners are familiar with the main components of the history taking process. The first component of a patient history is "Presenting the current (existing) complaint". Presenting the complaint may best be expressed in the patient's own words. The information presented can then be summarized by the clinician. The second component is the "history of the current (existing) complaint". Achronological approach should be used. This includes the following: when the condition/problem first started; the overall duration and progression of the condition, including whether it is episodic or constant and the nature and timing of any symptoms. It also includes details of any systemic signs or symptoms (such as fever); the success or otherwise of previous
treatments; and previous practitioners who have been consulted regarding the same or related condition(s). The third component is "Past
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medical history". Generic questioning regarding major systems such as the cardiovascular or respiratory systems is often the way dentists start obtaining a medical history. Questioning should then focus on specific disorders, such as asthma or other respiratory disorders, diabetes, hypertension, or other cardiovascular problems.
Structuring the interview is one of the important steps in taking medical history from patients. The ideal interview, whether a 5-minute assessment of therapy or a 50-minute history, is one ni which the patient feels secure and free to talk about important personal things.
Interviewing is an art that takes time and experience to develop. It is a skill as useful in daily patient care as it is to the person obtaining a comprehensive history. Your ability to project a sense of undivided interest in the patient is the key to a successful interview and patient rapport. As such, it is generally best to review records or new information and prepare equipment and charting materials before entering the room. When practical, the dental therapist (DT)or other clinician should know all available details of the patient case before the interview is started.
Your introduction establishes your professional role, asks permission to eb involved ni hte patient's care, and conveys your interest ni hte
patient. In this respect, the dentist should dress and groom professionally and enter with a smile and an unhurried manner. He should make
immediate eye contact, and fi the patient is well enough, introduce himself with a firm handshake or other appropriate greeting. State your role and the purpose of your visit, and define the patient's involvement in the interaction. Call the patient by name. Aperson's name is one of the most important things in the world to that person; use it to identify the patient and establish the fact that you are concerned with the patient as an individual. Address adult patients by title: Mr., Mrs., Miss, or Ms.-and their last name. Occasionally, patients will ask to be called by their first name or nickname, but that is the patient's choice and not an assumption to be made by the health care professional. Keep in mind that by using the more formal terms of address, you alert the patient to the importance of the interaction.
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Professional conduct shows your respect for the patient's beliefs,
attitudes, and rights and enhances patient rapport. So, be sure the patient si appropriately covered and position yourself so that eye contact is comfortable for the patient. Ideally, patients should be sitting up with their eye level with or slightly above yours, which suggests that their opinion is important, too. Avoid positions that require the patient to look directly into the light. Do not stand at the foot of the bed or with your hand on the door while you talk with the patient. This may send the nonverbal message that you do not have time for the patient. Ask the patient's permission before moving any personal items or adjusting in the room and remember that the patient's dialogue with you and the patient's medical record are confidential. The patient expects and the
law demands that this information be shared only with other professionals directly involved in the patient's care. When a case is discussed for teaching purposes, the patient's identity should be protected.

Be honest. Never guess at an answer or information you do not know. Remember, too, that you have no right to provide information beyond your scope of practice. Providing new information to the patient is the privilege and responsibility of the attending physician. Do not ever make moral judgments about the patient. Set your values for patient care according ot the patient's values, beliefs, and priorities. Belittling or laughing at a patient for any reason is unprofessional and unacceptable. The dentist should be mindful and respectful of cultural, ethnic,
religious, and other forms of diversity. He should also expect a patient to have an emotional response to illness and the health care environment and accept that response. Listen, then clarify and teach, but never argue.
If you are not prepared to explore the issues with the patient, contact someone who is. Adjust the time, length, and content of the interaction
to your patient's needs. If the patient is ni distress, obtain only the information necessary to clarify immediate needs. It may be necessary to repeat some questions later, to schedule several short interviews, or to obtain the information from other sources.
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A relaxed, conversational style on the part of the health care professional or the dentist with questions and statements that communicate empathy encourages patients to express their concerns. The dentist should expect and accept some periods of silence in a long or first interview. Both you and the patient need short periods to think out the correct responses. Then, he should close even the briefest interview by asking if there is
anything else the patient needs or wants to discuss and telling the patient when you will return.