| Identifier |
past_medical_history_part1 |
| Title |
Past Medical History Part 1 |
| Creator |
Andrew G. Lee, MD; Peter Wojcik |
| Affiliation |
(AGL) Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, Texas; Professor of Ophthalmology, Weill Cornell Medicine, New York City, New York; (PW) Class of 2020, Baylor College of Medicine, Houston, Texas |
| Subject |
History; Diagnosis; Interview |
| Description |
Outline: 1. Past Medical History a. Past medical history shapes present diagnosis b. Establish contributing factors to patient's current presentation c. Important Factors to Identify i. Chronicity ii. Co-morbid conditions iii. Treatments for chief complaint iv. Severity of comorbid conditions v. Treatments for comorbid conditions d. E.g. Patient with history of Lung Cancer i. Is this patient's cancer a cause of their current problem "X" ii. Key Elements 1. Staging-stage 1 vs stage 4 with metastasis a. Dictates likelihood of cancer as etiology of chief complaint 2. histology 3. Treatments--E.g. surgery, chemotherapy, radiation a. Ongoing treatments likely mean ongoing disease b. Treatments, side effects and treatments of side effects may indirectly be source of chief complain |
| Transcript |
So, we talked about the chief complaint and the HPI and I want to just share with you how I look at the past medical history a little bit different than you've probably been taught in medical School. The past medical history is predictive of the present and also of the future. So past is prologue. You need to know what the past is before you can determine what the person's present is. And so, for example, if someone has a history of lung cancer, we'd like to know how high of a chance is this lung cancer to be causing whatever they're here to see me in Neuro-Op for. And so, in order to do that I need to have the stage of the tumor, which means I need to know how extensive is the cancer. It can either be confined to the Lung. It can be outside of the lung. It can be a widespread metastasis. So, in a patient who has stage 1 lung carcinoma that's a totally different risk than someone who has stage 4 lung cancer for whatever their complaint is. And, we'd like to know what treatment the patient received. Because if they have extensive treatment or ongoing treatment, that also suggests that this lung cancer is actually active and causing whatever the problem is. So, we'd like to know if they had surgery, chemotherapy, radiation. And it can also be a side effect of the treatment of the disease. So, radiation, for example, has side effects that could affect us. Chemotherapy has ocular side effects that could affect us. Because it doesn't have to be the disease, Lung Cancer. It could be the treatment of the disease, the radiation, or a side effect of the treatment of the disease, immunosuppression from steroid treatment of radiation therapy. And you see how that can extend along. And so the key and differentiating feature when patient, any patient, who has cancer is we need to know what the grade is, we need to know the histology, we need to know the stage, we need to know the treatment, so that we can determine if there's side effects of the treatment or side effects of the treatment of the treatment of the side effect of the disease. In the past medical history past is prologue. |
| Date |
2019-10 |
| Language |
eng |
| Format |
video/mp4 |
| Type |
Image/MovingImage |
| Collection |
Neuro-Ophthalmology Virtual Education Library: Andrew G. Lee Collection: https://novel.utah.edu/Lee/ |
| Publisher |
North American Neuro-Ophthalmology Society |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Rights Management |
Copyright 2019. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6v45kpj |
| Setname |
ehsl_novel_lee |
| ID |
1469316 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6v45kpj |
