"The real conversation starts with curiosity. Not about what I want to document,
but curiosity about the person. It's about keeping the ability to be surprised awake
as Sigmund Freud called it. A conversation is the allowing of a real encounter.
And that means leaving behind the rules, avoiding typecasting and pigeonholing thinking."
(Prof. Dr. Giovanni Maio in an interview with Annette Bopp, free translation)
History taking or anamnesis (Greek anámnēsis = recollection) is defined by Neurath et al. (2006) as an interview or conversation with the patient. In the focus is establishing a relationship, gaining information, and discussing further procedures. Böker (2003) points out that the predominant focus on gaining information in medicine, in the form of increasingly detailed data, leads to a fragmented view of the human being and to a suppression of the therapeutic relationship component. In an interview, the medical ethicist Prof. Dr. Giovanni Maio also emphasizes the relevance of communication for the success of treatment, in which time and interpersonal relationships are the basis (Bopp 2019). These ideas are known, among others, from Balint (1964), Antonovsky (1997, pp. 33-47), Petzold (2005) and from the placebo research (Benedetti 2002; Di Blasi et al.2001). A survey by Bestmann et Verheyen (2010) shows that communication is one of the most important determinants of patient satisfaction and that it is precisely there that deficits can be identified. The average consultation time in German GP practices is seven minutes, with interruptions usually occurring after eleven to twenty-four seconds (Irving et al. 2017; Wilm et al. 2004). Kickbusch et Hartung (2014) and Erhard (2011) see the reasons for this deficiency in the lack of training in communication skills.
The osteopathic work enables a multiodal approach, which can first identify different facets of the patient in the history taking, the conversation. The claim to pursue a more holistic approach requires the implementation of this theory at all levels of therapist-patient interactions, including history taking.
The above-mentioned quotation from Prof. Dr. Maio reminds me in my osteopathic work to be constantly open and curious, to encounter the person with all his facets and to adjust my treatment accordingly.
*Note on the term "more holistic": in the sense of a lifelong learning process, I am reluctant to use a term that expresses an actual state. The term "more holistic" defines a goal, recognizes that a single person is not able to grasp the totality as such (cf. parable of the blind men and the elephant) and at the same time formulates the constant willingness to learn.
Literature:
Antonovsky, A. (1997). Salutogenese. Zur Entmystifizierung der Gesundheit. 1. Aufl. Tübingen: dgvt-Verlag.
Balint, M. (1964). Der Arzt, sein Patient und die Krankheit. 11. Aufl. London: Pitman Medical Publishing Co. Ltd.
Benedetti, F. (2002). How the doctor's words affect the patient's brain. Evaluation & the health professions 25 (4), 369–386.
Bestmann, B., Verheyen, F. (2010). Patientenzufriedenheit. Ergebnisse einer repräsentativen Studie in der ambulanten ärztlichen Versorgung. WINEG Wissen 01. Hamburg: Techniker Krankenkasse.
Böker, W. (2003). Der fragmentierte Patient. Arzt-Patienten-Beziehung. Deutsches Ärzteblatt 100 (1-2), 24–27.
Bopp, A. (2019). Wir brauchen unterschiedliche Zugänge zum kranken Menschen.Ein Gespräch mit dem Medizinethiker Prof. Dr. Giovanni Maio über die Fehlentwicklung in der heutigen Medizin. Gesundheit Aktiv 13/14 (Frühjahr 2019), 14–23.
Erhard, D. (2011). Ärztliche Gesprächsführung: So gelingt sie. Lege artis 1 (1), 14–18.
Irving, G., Neves, A. L., Dambha-Miller, H., Oishi, A., Tagashira, H., Verho, A., Holden, J. (2017). International variations in primary care physician consultation time: a systematic review of 67 countries. BMJ open 7 (10), 1-15.
Kickbusch, I., Hartung, S. (2014). Die Gesundheitsgesellschaft. Konzept für eine gesundheitsförderliche Politik. 2. Aufl. Bern: Verlag Hans Huber.
Di Blasi, Z., Harkness, E., Ernst, E., Georgiou, A., Kleijnen, J. (2001). Influence of context effects on health outcomes: a systematic review. The Lancet 357 (9258), 757–762.
Neurath, M., Lohse, A., Akat, K. (2006). Checkliste Anamnese und klinische Untersuchung: 173 Tabellen, Checklisten der aktuellen Medizin, 2. Aufl.,Stuttgart: Thieme.
Petzold, T. D. (2005). Die ärztliche Gesprächsführung im Sinne einer salutogenen Kommunikation. Erfahrungsheilkunde 54 (04), 230–241.
Wilm, S., Jnauf, A., Peters, T., Bahrs, O. (2004). Wann unterbricht der Hausarzt seine Patienten zu Beginn der Konsultation? Zeitschrift für Allgemeinmedizin 80 (2), 53–57.
Photography:
Rebecca Thoma
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