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The secret of the questions: medical interview in 21st century

      Despite the progress in diagnosis and disease management achieved over the last 20 years, the role of anamnesis in routine clinical practice has drastically changed [
      • Doi K.
      Computer-aided diagnosis in medical imaging: historical review, current status and future potential.
      ]. In fact, both the digitalization of healthcare system and an overwhelming technology have partially changed the daily clinical practice. Moreover, these new tools had resulted in a declining significance of medical history taking. Doubtless, patient management software allows to store many patient's information, to easily manage medical therapy and to check the possible drug interactions reducing the possibility of mistakes. Some previous studies suggested that computers are better than humans at making diagnoses [
      • Doi K.
      Computer-aided diagnosis in medical imaging: historical review, current status and future potential.
      ,
      • Engle Jr., R.L.
      Attempts to use computers as diagnostic aids in medical decision making: a thirty-year experience.
      ]. However, these multiple choices questionnaires' must be filled by physicians! Also in this case the importance of the question appears still essential. Indeed, high tech allows to collect the answers quickly but does not suggest the question to ask. Furthermore, this kind of management adsorbs most of the time which doctors should devote to talk to the patient. As known, full anamnesis and physical examination remain the cornerstone of medical practice [
      • van Tellingen C.
      About hearsay — or reappraisal of the role of the anamnesis as an instrument of meaningful communication.
      ]. Indeed, the medical interview is the tool most frequently used in medicine. Almost always, the type and quality of information obtained during the interview represent the basic requirement for achieving a successful diagnosis and treatment. We can say that the ability to take a good medical interview and interact with the patient is a fundamental skill, that each physician had to learn. However, more and more frequently, there is a tendency of considering the disease as only a biological dysfunction, in which the subjective symptoms and the meanings that patients attribute to them are not fully considered. Sometimes we are “worried” to fill a page on our computer or tablet with the patient's information but in that moment we are not really listening. In fact, listening is not hearing but is an active process in which a conscious decision is made to listen to and understand the messages of the speaker. It is also true that nowadays, time is not on doctor's side. Instead, it is important to remember that, especially in the first meeting with the patient, when a men or a woman tells his story to us, in some way is showing “Himself” or “Herself”. In the age we live in, which often is referred as “period of the technique”, we are increasingly looking for the efficiency. Moreover, technique have determinate the overturning of quantity into quality. What could be the fate of a medicine in a world that has nothing else in sight if not the perfecting and strengthening of its own instrumentations? A proper anamnesis is both a comprehensive and time-consuming exercise. The physician must be able to listen and at the same time to record the data, interrupting the patients and asking for details or explanations, if necessary. But, which it is the secret to record a good medical history? The question! More precisely, questions must be asked in the right way and in the appropriate moment. Indeed, questions posed in the wrong way determine not appropriate answers as well as bringing the wrong therapeutic attitudes. Furthermore, more serious consequences may occur in the case of no questions asked. The most important factors that triggers additional questions are the questions posed before. Questions on computers questionnaires, asked in mechanistic, represent a form of dehumanization of the relationship between the patient and physician. Anamnesis, and more in general patient-physician communication, should be based also on empathy [
      • Halpern J.
      What is clinical empathy?.
      ]. Indeed, it has been demonstrated that doctors who regularly include the psychosocial dimensions of care communicate better overall [
      • Oyler D.R.
      • Romanelli F.
      The fact of ignorance: revisiting the Socratic method as a tool for teaching critical thinking.
      ]. Rarely patients are able to describe organically their clinical history. Often data provided by the patient are confused and disordered. If we not formulate questions during the medical interview, the risk of getting partial or misleading information is very high. In this setting, medical doctors must use both counselling and Socratic method, also known as maieutic. Socratic method could allow doctors to recognize the deep structure of questions and use the critical thinking process into daily clinical practice [
      • Oyler D.R.
      • Romanelli F.
      The fact of ignorance: revisiting the Socratic method as a tool for teaching critical thinking.
      ]. A dialectical method between individuals is fundamental to allows an active listening. The aim of the medical interview is to bring out patient's information that are sometimes ignored or inadvertently unreported by himself. Are we still able to perform a complete medical interview in period of healthcare digitalisation? Will be next generations of doctors able to do it? In this context is important to observe that current medical curriculum gives more importance to laboratory study and microscopic investigation while the interaction with the patient is often ignored. Moreover, recent medical textbook often not emphasis the role of the anamnesis but stressed the interpretation of specific signs and/or symptoms. As final result, the study of clinical history might be dangerously neglected by future doctors. Furthermore, in a period where costs are very important in the health sector, a complete medical history may provide a precise clinical clue, accelerating diagnosis and treatment with a minor period of hospitalization and reducing the burden of costs of healthcare system [
      • Grüne S.
      Anamnesis and clinical examination.
      ]. Looking into the future, we have obviously to use and recognize the superiority of high-tech medicine but we can't ignore the fundamentals on which medical professionalism was built: communication with our patient. Future doctors must be trained to interact with their patients and also in use high technology. As physicians the person, not just the illness, should always remain our primary concern.

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      References

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        Computer-aided diagnosis in medical imaging: historical review, current status and future potential.
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        Attempts to use computers as diagnostic aids in medical decision making: a thirty-year experience.
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        What is clinical empathy?.
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        The fact of ignorance: revisiting the Socratic method as a tool for teaching critical thinking.
        Am J Pharm Educ. 2014; 78: 144
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        Anamnesis and clinical examination.
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