The role of the routine clinical history

Twenty-two final year clinical medical students, twenty-two pre-registration house physicians and twenty-two post MRCP (U.K.) registrars were studied during the clinical interview by the method of videotape-stimulated recall. It was found that the course of the clinical interview was determined by three thinking processes. There was no significant difference between the students, house offers and registrars in the extent to which their interviews displayed these thinking processes. Taking all subjects together, however, there was a significant difference in overall frequency of usage of the processes. The results show that students and doctors largely conduct the clinical interview according to either demands of their own interpretation of clinical information as it is gathered or the requirements of the routine but usually by a combination of both. The active role of the interviewer in following his/her own interpretative needs is the most important feature of our findings. The routine inquiry was used by all groups as a failsafe or background search mechanism. Increased knowledge of these thinking processes among students and teachers of medicine may lead to a more realistic and efficient balance in the teaching and learning of the clinical history.