The previous chapter went into some detail about effective history-taking. This chapter shows how to use the information you gained to plan the management of your patient.

What’s Next?

Having taken a careful history, you may have all the information you need, but more likely you may find yourself in a situation where you have some ideas about what’s going on but not all you need to know. The big question now is not ‘what’s the diagnosis?’ but ‘what’s next?’ What do you need to do to take management to the next stage?

Examining Your Patient

Most clinical skills guides think of the history and examination as one item, but it’s worth thinking of the examination as part of your investigations and plan it on the basis of what you’ve discovered in the history.

• As with the history, the focused examination explores areas chosen because they are likely to be important based on what you have found in the history.
  
• It’s more revealing to do a thorough examination of the system where you believe the problem lies than a ‘fishing trip’ which skims over everything.
  
• Always do the examination that the clinical situation demands. Patients who need a rectal exam in surgical outpatients need it just as much in general practice.

Investigations

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