PHYSIOLOGICAL HISTORY

PHYSIOLOGICAL HISTORY is also called PERSONAL.

We begin to investigate the birth of the Patient and the methods of delivery.

I have sometimes observed diligent doctors in training, Herodotian historians, persistently insisting on trying to find out from patients, perhaps almost centenarians, the methods of their birth and inviting them to… remember.

A birth is defined as eutocic (from the Greek eu=good and tiktein=to produce) when it occurs in a physiological manner; it is defined as dystocic (the prefix dis in Greek indicates a disorder) if its completion requires any technical intervention by the Doctor.

Now: it is not always the rule that each of us knows exactly how we came into the world, unless we have suffered from pathologies resulting from birth injuries or our parents have told us.

In fact, knowing whether you came into this world through natural birth in cephalic presentation or taken by the feet by the midwife (breech presentation) or taken right from the start by... the bottom (presentation... which however I find very rare at the beginning of our lives, but which unfortunately we all experience sooner or later), has little importance.

Let's not even talk about requests regarding birth weight or breastfeeding or paid breastfeeding, that is, breastfeeding carried out by paid wet nurses (an occurrence that has been obsolete for years, but in Rome Ciociara wet nurses were highly sought after), and therefore teething.

Regarding somatic development and psycho/social evolution with scholastic achievement, we usually ask about the level of education achieved, but not so much because this could influence in some way the pathology in progress, but rather to realize who we are dealing with in order to adequately prepare our questions and therefore know something about the family conditions.

Men were once asked for information about their military service: here I think it is appropriate to recall the following.

When I was still a young doctor, about 40 years ago, we were investigating the period of the Second World War, because many Italians had suffered the "pains of hell" in very difficult situations in various parts of the world and had sometimes contracted infectious or parasitic diseases of various types.

A thought for everyone goes to my Dad who lived in Messina for the first 30 years of his life, but then sent to Tobruk in North Africa as a Medical Officer, during the Second World War, and then deported to India in Bangalore for 5 years as a prisoner of the English (fortunately without contracting any diseases, at least the…visible ones)

Now that military service is no longer mandatory and could even be an issue that concerns women, the question may make sense for those who have possibly served in peacekeeping missions somewhere in the world, obviously hoping that useless wars will never be fought again.

For immigrant subjects, especially non-EU citizens, it may be interesting to ask for information on the places and ways of life and the psycho/physical development, which sometimes took place in very difficult or even dramatic environments and situations, where exposure to infectious agents may have been the rule.

The interview about a woman's physiological anamnesis must certainly be much more in-depth.

First of all, you will need to ask the age of menarche, or the age of the first menstruation (from the Greek: αρχή “beginning”), which in our area usually occurs between the ninth and eleventh year of life.

We will then move on to asking for information on the progress of the menstrual cycles regarding the rhythm and whether these are regulated through the intake of female hormones (for example "the contraceptive pill") or whether they are absent (amenorrhea where the prefix -a-, from the Greek, expresses a deprivation or absence) and since when, and therefore whether the flow and duration of menstruation are constant and regular and finally whether the woman has experienced blood loss during intermediate periods.

This information is also very important to detect, for example, the presence of menometrorrhagia, or very heavy menstrual flows.

Usually during a menstruation a woman loses, on average, 35 ml of blood; but male doctors in training should not imagine that their female colleagues measure this quantity every month in precious stills.

It would be like saying that a healthy, powerful young man lost count at 199 million sperm per milliliter of semen in his ejaculate and worried about the missing million.

Irony aside (but I have learned not to be surprised by anything), which is certainly important because women often do not carefully observe any unwanted increase in menstrual flow, an event which instead causes hypochromic and hyposideremic anemias which are otherwise inexplicable.

A good way to investigate, although not completely objective, is to ask the Woman how many sanitary towels she changes per day during menstruation and, given that many Women, rightly concerned about their intimate hygiene, change industrial quantities as soon as they are "dirty", it is necessary to ask if the sanitary towels changed are heavily soaked with menstrual blood; this will lead to some obvious conclusions.

We will then investigate the number of pregnancies, the age at which they occurred and their progress, breastfeeding, whether it occurred physiologically and for how long, as well as the number of any spontaneous or induced abortions.

Information on the health status of the children will be obvious and consequential.

If the woman is of a compatible age, she will finally be asked about menopause: age at which it occurred, possible presence of associated symptoms or taking replacement therapy.

Some women will report surgical menopause, that is, early menopause following ablative surgical interventions on the uterus and/or adnexa; the reasons for these events will need to be investigated.

It is good practice, both for men and women, to inquire about their sexual activity, with discretion and therefore certainly not asking if they have preferences different from the genetically determined sex or how many orgasms they reach per week (lucky them!) or if they masturbate daily, but only asking if they consider it satisfying or if instead it is a source of anxiety or neurosis: do not underestimate this aspect because, even if it is not always fundamental for the well-being of each of us, especially at a certain age, it is certainly very important.

Whatever answer you receive in this regard (I could tell you stories worthy of the best Crozza), don't laugh, don't blush and don't comment, but, perhaps, ... cut it short, because some "Latin lovers", more or less boastful, will consider themselves second only to Giacomo Casanova, but ... just barely.

We will then move on to investigate the patients' lifestyle.

I am not aware of any spaces in the medical records under the heading Anamnesis in its various phases relating to the environment in which one lives or one's work activity or usual habits.

In our area, for better or worse, places or environments of life are at least decent (at least apparently if you think for example of the "land of fires"), but until a few decades ago there still existed unhealthy environments infested for example by malaria.

Many subjects are then very stressed or dissatisfied with their work or carry out activities that put them at risk (e.g. due to particular exposure to chemical or bacterial agents) or lead a completely sedentary life: in short, all information that is worth acquiring and that perhaps could then be connected in some way with the Near Pathological Anamnesis.

In all medical records, however, under the heading “Lifestyle”, information on nutrition must be collected: type, variety or restrictions induced by some particular situation or any recent changes resulting from the onset of some symptoms.

From this it follows that you are asked about your usual weight and any increase or excessive weight loss in recent periods, which should be expressed as a percentage, if significant.

We will then move on to investigate the habitual intake of alcoholic beverages: quantity, type, timing of intake during the day (on an empty stomach or during meals)

Be careful because often, following these questions, people lie when giving their answers and, for example, the new Casanovas suddenly become Saint Francises.

However, it should be considered that drinking a glass of wine or beer with a meal and, occasionally, spirits (whiskey, brandy, etc.) is considered normal and that someone who drinks maybe two glasses of wine with a meal certainly cannot be defined as an alcoholic.

Patients almost always lie about smoking cigarettes , both about the number and about when they started smoking, as if the doctor could send them to hell as great sinners and not notice, after a careful objective examination of the chest , that the lungs have suffered much more serious damage than the few cigarettes they have declared they smoked.

For Us Doctors, a habitual smoker of more than ten cigarettes a day must be labeled and considered a “heavy smoker”, with all that this obviously entails.

Even the habitual use of soft drugs or the intake of narcotic substances must be asked and transcribed, explaining to the Patient that such information has only clinical value and that it will certainly not be transferred to the……narcotics.

Information will then be requested about the bowel movement (mode of defecation), whether physiological or tending towards constipation or diarrhoea, and about urination (urine output), whether physiological or whether there is dysuria (difficult urination), pollakiuria (frequent urination) with nocturia (night-time urination), polyuria (large quantity of urine output) or vice versa oliguria (small daily quantity), stranguria (painful urination, perhaps with burning), or there is an inability to hold back the urge (incontinence).

It is obvious that to interpret the characteristics of bowel and urination we will use understandable terms and certainly not technical ones, then translating from "patient-speak" into "medical-speak" what the Patient tells us.

Be careful because patients often interpret pollakiuria as polyuria (especially male subjects affected by prostatic hypertrophy) and few subjects, in truth, know that physiologically they should produce at least 1200 ml of urine per day.

Usually requests for information about the presence or absence of allergies are left last (and who knows why!)

Here the discussion becomes a bit complicated, to tell the truth, and sometimes one risks remaining on the... generic.

It is certainly important to know and report if the Patient suffers from allergies or intolerances to particular foods or if he is sensitive to certain pollens or environmental allergens (dust mites should not be present in a hospital) or suffers from particular contact allergies; however, the important aspect of this investigation is another.

The important thing is to know if and to which drugs the Subject is allergic, because, as those who read me will surely know, the administration of a drug to which the Subject is allergic could cause a very serious anaphylactic shock.

Many patients know the drugs they are allergic to (unfortunately sometimes due to sad personal experiences) but most of the time they report the commercial name.

Now, if the person conducting the interview is a young student, he may not know the chemical composition of the drug in question and the active ingredient, so he will have to ask his tutor.

In fact, in the medical record, the incriminated active pharmacological ingredient must be clearly highlighted, perhaps in red, and the nursing staff must be informed of this.

I realize that this article is a bit long but I hope that my Readers will not begrudge me, because the careful and complete collection of the Physiological or Personal Anamnesis is a fundamental moment of the Interview.

It is worth remembering here that the Doctor should not only be interested in the pathology of the diseased organ responsible for the hospitalization; but the Patient should be considered in all his physical and mental entirety.

It is no coincidence that today we speak of Holistic Medicine from the Greek olos which means “whole” and this should never be forgotten.