From Patient Story to Clinical History
"Mother said he had fever. Then she gave paracetamol. Then he slept. Then he cried. Then he vomited. Then grandmother gave herbal medicine. Then they went to the clinic. Then the doctor gave antibiotic. Then he still had fever. Then they came here."
"A 4-year-old boy presented with high-grade continuous fever for 5 days, partially responsive to antipyretics. Fever was associated with persistent vomiting — 5 to 6 episodes per day — and poor oral intake. No response to a 3-day course of empirical antibiotics. No localising symptoms. No rash, cough, or urinary symptoms."
A chronological account of events as experienced and reported by the patient or family. Emotionally framed, unfiltered, and complete — including details that are clinically irrelevant.
A medically interpreted, filtered, and structured account that organises events by clinical significance, characterises symptoms with precision, and constructs a coherent argument toward diagnosis.
Time is the backbone of clinical narration. The sequence of events — when symptoms started, how they progressed, what changed — is the structure on which everything else hangs. Establish the timeline before anything else.
Ask: When did it start? What came first? What followed? What is the situation now?
Not everything said is clinically important. The name of the clinic they visited — this is background, not foreground. Remove noise. Keep signal.
The test: does this detail influence the diagnosis, severity assessment, differential, or management? If not — it belongs in the social history or nowhere.
Every symptom must be clothed with modifiers. This is the direct application of The Importance of Adjectives . Adjectives are not decoration. They are the diagnostic content.
A good narrative is a medical argument. Every sentence moves the listener toward a diagnostic conclusion. You are not reporting events — you are constructing meaning.
One or two sentences stating the primary problem and its duration. This sets the frame for everything that follows. It should be clinically described — not the patient's exact words.
When exactly did this begin? Was it sudden or gradual? Was there a preceding illness, trigger, or exposure? Onset often points directly to aetiology.
How has the illness progressed? Improving, static, or worsening? Trajectory is one of the most powerful differentiating features — many diagnoses are defined by their evolution, not just their presentation.
What other symptoms accompany the main complaint? These build the clinical picture and support or challenge the working diagnosis. Always characterise associated features — never just list them.
Deliberately stated absences of features that would have been expected if certain diagnoses were correct. Negative findings are evidence — as established in Note 5. They belong in the narrative, not just in the examination.
How is the patient right now — at the time of presentation? This is where severity is communicated. Always include a severity descriptor as in Note 8. This is what drives the immediate management decision.
Ask yourself this before every presentation — ward round, viva, handover. If the answer is no, reorganise before you present. The team receiving the handover is hearing it for the first time. Your narrative is the only lens they have.