Chronology of Disease – Illustrated

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  • A fundamental mistake of students and junior doctors is to create a differential diagnosis without taking a careful history of the chronology of the history of the presenting complaint
  • Chronology consists of two dimensionstime course and the magnitude of the symptoms
  • It is not enough to simply identify the symptoms and their duration but how they changed over time
  • Useful questions include, ‘How bad were your symptoms when they first started’, ‘How have they changed since then?’, ‘Do they come and go or were persistent’,  ‘At what point did they become severe enough to seek attention and why?’
  • When evaluating past and acute episodes, it is worthwhile identifying potential precipitants that might suggest a cause.
  • In the following 6 graphics, the main complaint is dyspnoea but the time course suggests vastly different possibilities

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