Arrangement:  This description deals with the taking of an extended history in the physician's office: the patient is in no acute distress, time limitations are not urgent, and the disease is relatively obscure. Circumstances often vary greatly from these stipulations. The conversation should not be overheard by others, although the presence of the patient's spouse or a relative is often helpful in confirming the narrative and supplementing the patient's observations. We prefer to limit a single interview to the patient and one other informant; more informants waste time in their disagreements on details that outweigh the slight extra yield of information.

Physician's Manner: Present to the patient the appearance of being unhurried, interested, and symphatetic, to obtain his confidence and rapport. In no way should you express adverse moral judgement on his actions. Permit him to begin his story in his own way; listen for a short time before gradually injecting questions to guide the interview. Gently but firmly keep the discussion centered upon the patient's problem. By all means. avoid discussing your own health, even when he invites you. One of us knew a resident who violated this injunction on a women's ward. On rounds each morning the patients interrupted our interviews with them by anxiously inquiring about the health of "poor Dr. X's health needed no attention.

Writing:  Write sparingly while the patient talks. After you have recorded some routine data on vital statistics, sit back and listen to the narrative for a few a while, interjecting only a few questions. Avoid writing the patient's narrative verbatim; it is too lengthy and poorly organized. After obtaining the present illness, take time to write it down. Then write the past history as it is elicited by your questions.

Use of Language:  From the beginning, gauge the patient's understanding of the language; words may have different meanings for both of you. Put your questions in simple nontechnical words. Even lay words may be misunderstood; the English vocabulary is vast and formidable to the scolar. Excluding your scientific and medical vocabulary, you may be able to use 100,000 words, while the adult with average education gets along with 30,000 to 60,000. So the patient may not know half the words you may use in English. Patients often leave the interview with the fear they have presented their symptoms poorly because they have answered question they did not understand.

Patient's Motivation: The use of the history to secure diagnostic clues depends on the tacit assumption, frequently forgotten, that the patient's description of his symptoms is truthful, because his sole motive is to assist the physician in treatment. As far as possible, this assumption must be confirmed by excluding other motives that might prompt misrepresentation of the facts. Many patients, entirely truthful, because his sole motive is to assist the physician in treatment. As far as possible, this assumption must be confirmed by excluding other motives that might prompt misrepresentation of the facts. Many patients, entirely truthful, present symptoms that are baffling until the physician learns their resemblance to those of a friend or relative who has died of cancer and the patient fears the same fate. The physician must ascertain whether the patient is contemplating a lawsuit for damages, claiming workman's compensation, or applying for war veteran's benefits. The narcotic addict presents symptoms calculated to obtain drugs. Lacking discernible motives, a few patients fabricate medical histories that defy the psychiatrist's attempts to explain (Munchausen's syndrome).