Symptoms and Diagnosis
Usually the first consultation will take up to an hour. The patient's narrative is listened to, recording when the problem started, how it developed and what makes the particular symptoms better or worse; such as heat or cold and the position the patient adopts.
Even with acute illness, characteristics relating
to the whole person may be important. For instance,
the patient may usually feel the cold, but with an
infection they feel very hot and want to be uncovered
with the window open. The time of day when the
patient feels best or worst and other general symptoms may be relevant.
In chronic illness, it is even more important to find out if the environment affects the patient: heat or cold, damp or dry weather, mountains or seaside. These variable factors, or modalities, are important in understanding the patient's constitution.
Although the problem may not involve the digestive system it is
important to know whether there are any food likes or dislikes: be it the
type of food, or its being sweet, sour, or salty; and when there is a thirst,
if it is for large or small amounts.
Sleep is usually restorative and since an illness may affect this, it is helpful to enquire about sleep quality, if there are dreams, what position is most comfortable and whether the patient wakes refreshed. Mood changes, and when they occur, need to be considered as well as other symptoms relating to the mind: such as fears, anger, tearfulness, desire to be alone or have company.