Techniques of enquiry

Consider the following dialogue between a doctor and his patient: Doctor

Hi Bill, come in and sit down. (Doctor notices a limp as Bill walks to a chair.) That looks like a nasty limp. It must be really difficult for you to get around. I bet it’s painful too, isn’t it?

Bill

Well, yes Doctor, that’s what I came to see you about. For the past week I’ve had this dreadful swelling in my foot. I thought at first I’d been stung by something while I was working in the garden but it hasn’t gone away and I must admit I’m a bit worried.

Doctor

When did you first notice it?

Bill

Well on Monday morning my big toe was very sore and by Tuesday it had spread to the whole of my foot.

Doctor

Does it hurt if I press here? (Doctor presses ankle.)

Bill

No, not really, well maybe just a little bit.

Doctor

And how about here? (Doctor presses calf muscle.)

Bill

No that’s all right.

Doctor

What about here on the arch of your foot?

Bill

Ouch! Gosh, that’s really painful!

Doctor

Well I don’t think it’s anything to worry too much about. If it had spread up to your leg, I would have been a bit concerned, but it is confined to your foot and I noticed here on your big toe a small puncture – possibly it was caused by a spider bite.

Bill

That’s interesting. Here, let me see.

Doctor

What I suggest is that I give you some anti-histamine tablets to take, and if it’s not better by Thursday, come back and see me.