Chief Complaint and History of Present Illness
The psychiatrist elicits the patient's chiefcomplaint in his or her own words and follows with the history of the present illness, including the onset, course, progression, and medications if any, along with the current medical and psychiatric symptoms and illness chronology. It is important for establishment of rapport to allow the patient to tell the story of the illness in his or her words with minimal interruption or intrusion except for occasional redirection. Although the psychiatrist may wish to have a thorough review of the history in chronological order, it is better to allow the patient to provide the story and for the psychiatrist to reconstruct the chronology by asking questions if the history is unclear. Allowing the patient to tell his or her story enables the psychiatrist to observe for cognitive impairment and to determine whether the patient is an accurate historian. Hearing the history of present illness recounted as a story often provides more information about remote and recent memory than does routine questioning. Following leads is more useful than proceeding on a set course of history-taking that may serve to derail an anxious patient. A comprehensive psychiatric assessment of a person with HIV or AIDS would not be complete without a determination of the patient's understanding of his or her illness and its treatments (Cohen 1986, 1987, 1992; Cohen and Weisman 1988; Cohen and Alfonso 1998, 2004).
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