Establishing a New Approach to Clinical Health History

3 Establishing a New Approach to Clinical Health History



Peter M. Rabinowitz, Lisa A. Conti


Despite the growing sophistication of medical technologies for imaging and chemical diagnosis of disease states in both human and veterinary patients, the clinical history remains a critical part of medical decision making in human and animal health care. In an era when human health care providers and veterinarians rarely visit the homes, neighborhoods, and workplaces of their clients, the process of history taking remains the principal method of gathering information about environmental factors that could be relevant to the health status of the patient.


Despite a growing realization of connections between the health of human beings and other animals living in close proximity, the idea of a human health care provider including in the evaluation of a patient any directed questions about the contact with companion and other animals may seem foreign to many clinicians. Animal exposures are often overlooked during medical evaluations. A study of primary care physicians found that the majority of the time they failed to take a history of animal exposures when evaluating patients with presumed infectious gastroenteritis and diarrhea.1 Possible exposures to pet shops, exotic and domestic pets, farm animals/environments, and zoos and other wildlife centers, although apparently clinically relevant, were routinely omitted in the medical history. As a result, the study authors concluded that a significant number of zoonotic disease events are missed. As explained in Chapter 2, potential exists for both missed diagnoses2 and medicolegal liability in overlooking the importance of animal exposures when taking a medical history. For the veterinary clinician as well, there is some potential legal liability for overlooking a zoonotic or other human-animal–related health risk.


This chapter outlines essential elements of human-animal health concerns that should be (1) included in the clinical history taken by human health care providers and (2) asked of animal owners by veterinary health professionals.



ANIMAL HEALTH INFORMATION IN THE HUMAN MEDICAL HISTORY


Human health care providers should routinely ask questions about animal contacts as part of the medical history for four major reasons:


1. To identify possible zoonotic disease risks, thereby facilitating the diagnosis and prevention of disease transmission from animals to the patient.

2. To determine whether animals nearby could be a source of allergen exposure (see Chapter 7)

3. To understand the patient’s psychosocial issues, including the emotional bond between a patient and one or more companion animals, the effect of animal care and feeding on daily routines, and the warning signs of neglect or abuse of an animal. Animals may be more significant in a patient’s life than other social support networks that are routinely asked about in the social history (see Chapter 5)

4. Asking about the health of animals living nearby could provide information about toxic and infectious exposures in the environment as well as whether animal medications are stored in the house and could pose a risk to human beings.

In addition, asking about animal contacts may increase the rapport between clinician and patient, allow a better understanding of family relationships and health beliefs, and provide additional information about the patient’s daily routine and environment.



Animal Contact History as Part of the Acute Care Visit


During an acute care visit, time available for history taking can be limited and priority must be given to the most important medical information gathering. At the same time, failure to gather important information about animal contacts, especially if no baseline data exist in the chart, can increase the risk of missing important clues to the correct diagnosis and treatment of the acute condition. Therefore it may be appropriate to ask several brief screening questions about animal contacts as part of the history of a patient with an acute illness.


Some patients may be surprised by their health care provider asking questions about family pets or other animals. The health care provider can begin these questions with an explanatory statement, such as:



These days, we are discovering that several diseases may pass between people and pets or other animals. I’m going to ask you some routine questions about pets in the house and any other animal contacts that you may have, and whether your pets have had any health problems. This information can help me know whether there could be any connection between the health of animals that you live with and your health concerns.


Table 3-1 lists screening and follow-up questions for the acute care visit. The general screening questions can be modified for the particular situation, and examples of modified screening questions appear throughout this book (see, for example, Chapter 10). If the response to any of the screening questions is “yes,” additional follow-up questions are indicated. Specific follow-up questions are mentioned in other sections of this book.


Table 3-1 Screening and Follow-Up Questions for the Acute Care Visit










Screening and Follow-Up Questions About Animal Contacts
If the following screening questions are answered “yes,” Ask these follow-up questions:

1. Do you have pets or other contact with animals?

Related posts:

  1. The Built Environment and Indoor Air Quality
  2. Shared Strategies to Maximize Human and Animal Health
  3. Public Health and Human-Animal Medicine
  4. Zoonoses

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Aug 6, 2016 | Posted by in INTERNAL MEDICINE | Comments Off on Establishing a New Approach to Clinical Health History

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