The effect of the illness are;
A serious illness can change a person’s life—for example,
a chronic illness may prevent work or further education.
The psychological and physical effects of a serious health
problem may be devastating and, of course, people
respond differently to similar problems. Even after full
recovery from a life-threatening illness, some people
may be permanently affected by loss of confidence or
self-esteem. There may be continuing anxieties about
the capability of supporting a family. Try to find out
how the patient and his or her family have been affected.
How has the patient coped so far, and what are the
expectations and hopes for the future with regard to
health? What explanations of the condition has the
patient been given or obtained (e.g. from the internet)?
Helping a patient to manage ill-health is a large
part of the clinician’s duty. This depends on sympathetic
and realistic explanations of the probable future course
of the disease and the effects of treatment.
DRUG AND TREATMENT
HISTORY
Ask the patient whether he or she is currently taking
any tablets or medicines (the use of the word ‘drug’
may cause alarm); the patient will often describe these
by colour or size rather than by name and dose.c Then
ask the patient to show you all his or her medications
(see Fig. 1.2), if possible, and list them. Note the dose,
length of use, indication for each drug and any side
effects.
This drug list may provide a useful clue to chronic
or past illnesses, otherwise forgotten. For example, a
patient who denies a history of high blood pressure
may remember when asked why he or she is taking an
antihypertensive drug having an elevated blood pressure
in the past. Remember that some drugs are prescribed
as transdermal patches or subcutaneous implants (e.g.
contraceptives and hormonal treatment of carcinoma
of the prostate). Ask whether the drugs were taken as
prescribed. Always ask specifically whether a woman
is taking the contraceptive pill, because many who take
it do not consider it a medicine or tablet. The same is
true of inhalers, or what many patients call their ‘puffers’.
To remind the patient, it is often worthwhile to ask
about the use of classes of drugs. A basic list should
include questions about treatment for:
• blood pressure
• high cholesterol