Dr. John Frain is Clinical Associate Professor and GEM Director of Clinical Skills at the University of Nottingham, UK.

• Preface xxiiiAbbreviations xxv1 Exploring Symptoms 11.1 This History of the History 11.2 What Is a Symptom? 31.3 What Do Patients Want from Their Clinicians? 61.4 The Structure of a Medical History 81.5 Clinical Communication 111.6 The Opening Statement and Agreeing the Agenda 121.7 How Does the History Work? 151.8 Sources of Bias in the History 181.9 Ethnicity and Health 191.10 Statistical Concepts 23Acknowledgements 24References 242 The Skin 272.1 Symptoms of Skin Disease 272.2 About Dermatology 272.3 Burden of Skin Disease 282.4 Skin Anatomy 292.5 Skin Physiology 322.6 Assessing Skin of Colour (SOC) 322.7 Key Points of the History 322.8 The Patient Experience of Skin Disease 342.9 Itch (Pruritis) 342.10 Colour of Skin When Inflamed 372.11 Description of Skin Lesions 382.12 Assessing Conditions in Skin of Colour 382.13 Eczema 422.14 Psoriasis 442.15 Skin Appendages 442.16 Nails 452.17 Wounds 45References 463 Respiratory 513.1 Ear, Nose and Throat 513.2 Lower Respiratory Tract 573.3 Anatomy and Physiology of the Lower Respiratory Tract 583.4 Symptoms 583.5 Cough 593.6 Breathlessness 613.7 Wheeze 643.8 Sputum 653.9 Haemoptysis 663.10 Chest Pain 693.11 Symptoms Clusters in Respiratory Disease 71References 714 Cardiovascular 754.1 Global Burden of Cardiovascular Disease 754.2 Key Symptoms of Cardiovascular Disease 774.3 Prevalence of Symptoms 774.4 Assessment of Cardiovascular Risk 774.5 Pain 824.6 Breathlessness 904.7 Palpitations 934.8 Swelling (Oedema) 964.9 Syncope 99References 1015 Gastrointestinal 1055.1 Overview 1055.2 Global Burden of Gastrointestinal Disease 1055.3 Anatomy and Function 1065.4 Key Gastrointestinal Symptoms 1085.5 How Common Are Gastrointestinal Symptoms? 1085.6 Difficulty Swallowing (Dysphagia) 1105.7 Dyspepsia 1145.8 Nausea and Vomiting 1195.9 Haematemesis 1215.10 Abdominal Pain 1225.11 Bloating and Distension 1255.12 Change in Bowel Habit 1295.13 Anatomy and Physiology of the Colon 1305.14 Jaundice 132Acknowledgements 135References 1356 Endocrine and Multisystem Symptoms 1396.1 Structure and Function of the Endocrine System 1396.2 Endocrine Symptoms 1406.3 Burden of Disease 1406.4 Ethnicity 1426.5 Lgbtq+ 1426.6 Fatigue 1426.7 Fever/Chills/Night Sweats 1466.8 Sepsis 1496.9 Key Points in the History 1516.10 Unintentional Weight Loss 1516.11 Weight Gain 1536.12 Dizziness 1546.13 Thirst and Polyuria 1566.14 Skin: Rashes/Bruising 1566.15 Flushing 1596.16 Long Covid 160References 1637 Musculoskeletal 1677.1 Symptoms of Musculoskeletal (MSK) Disease 1677.2 Burden of Musculoskeletal Disease 1677.3 Community Prevalence of Symptoms 1687.4 Distribution of Symptoms and Signs 1697.5 Key Points in History-taking 1707.6 Pain 1717.7 Stiffness 1737.8 Swelling 1747.9 Loss of Function 1757.10 Activities of Daily Living 1767.11 Extra-articular Manifestations 1777.12 Specific Joints 1797.13 Neck 1797.14 Thoracolumbar Spine 1807.15 Shoulder 1817.16 Elbow 1827.17 Hand 1827.18 Hip 1837.19 Knee 183References 1868 Neurological 1918.1 Impact of Neurological Disease 1918.2 Ethnicity 1918.3 Lgbtq+ 1928.4 Approaching the Neurological History 1928.5 Key Neurological Symptoms 1948.6 Headache 1948.7 Altered Mental Status 1988.8 Seizures 1998.9 Weakness 2028.10 Sensory Symptoms 2058.11 Tremor 2068.12 Visual Disturbance 2078.13 Gait Abnormality 2088.14 Speech Abnormalities 209References 2119 Urinary 2159.1 Burden of Urinary Problems 2159.2 Community Prevalence of Urinary Symptoms 2159.3 Ethnicity and Urinary Symptoms 2169.4 LGBTQ+ Experience 2169.5 Anatomy and Physiology of the Urinary Tract 2179.6 What Causes Symptoms of the Urinary Tract? 2189.7 Dysuria 2199.8 Urinary Frequency 2219.9 Urgency 2229.10 Nocturia 2239.11 Haematuria 2249.12 Pain from the Urinary Tract 2269.13 Incontinence 2289.14 Prostatic Symptoms 2309.15 Symptoms of Chronic Kidney Disease 232References 23310 Gender, Sexuality and Reproduction 23710.1 The Scope of the Sexual History 23710.2 Epidemiology of Gender, Sexual and Reproductive Symptoms 23810.3 Sexual Orientation 23910.4 Barriers to Taking a Sexual History 24010.5 Non-consensual Sex 24010.6 Health Professionals’ Roles in Discussion and Treatment of Non-consensual Sex 24110.7 Gender Dysphoria 24110.8 Vaginal Discharge 24510.9 Normal Menstruation 24710.10 Dysmenorrhoea 24710.11 Heavy Menstrual Bleeding (HMB) 25010.12 Pelvic Pain 25210.13 Menopause 25410.14 Sexual Dysfunction 25510.15 Erectile Dysfunction 25610.16 Female Sexual Dysfunction 25810.17 Fertility Problems 25910.18 Breast Lump 261References 26311 Mental Health 26711.1 Impact of Mental Health Disorders 26811.2 Stigma and Discrimination 27111.3 Community Prevalence of Mental Health Symptoms 27111.4 Social Determinants of Mental Health 27111.5 Ethnicity and Mental Health 27211.6 LGBTQ+ and Mental Health 27211.7 The Patient Experience 27311.8 Approaching the Mental Health Interview 27311.9 Anxiety 27511.10 Mood Disorders 27611.11 Thought Disorder 28011.12 Sleep Disorders 28211.13 Memory Change 28411.14 Personality Disorders 28711.15 Self-harm 28911.16 Suicide 29011.17 Assessing Risk of Self-harm and Suicide 291References 29112 Babies and Children 29712.1 Burden of Disease in Childhood 29712.2 Social Determinants of Health 29712.3 Ethnicity 29812.4 Phases of Childhood 29812.5 Exploring Symptoms of Babies and Children 29912.6 Signs of Serious Illness in Babies 30112.7 Feeding and Growth 30112.8 Development 30312.9 Cardiovascular Disease 30512.10 Respiratory 30912.11 Neurological 31012.12 Gastrointestinal 31112.13 Musculoskeletal Symptoms 31212.14 Cancer in Children 31212.15 Emotional Disorders 31312.16 Autistic Spectrum Disorders (ASD) 31312.17 Attention Deficit Hyperactivity Disorder (ADHD) 31612.18 Adolescence 31712.19 Gender Identity and Sexual Orientation 31712.20 Sexual Orientation Symptoms in Children 319References 31913 Elderly Care 32513.1 Global Burden of Disease in Older People 32513.2 Ethnicity and Ageing 32613.3 LGBTQ+ and Ageing 32613.4 Normal Ageing 32713.5 Symptoms in the Elderly 32713.6 Key Tips in Taking a History 32913.7 Multimorbidity and Comorbidity 32913.8 Frailty 33013.9 Falls 33313.10 Appetite and Weight 33813.11 Hearing and Vision 33813.12 Mobility 33913.13 Mental Health 34013.14 Sexuality 34113.15 Elder Abuse 343References 34414 Functional Symptoms 34914.1 Introduction 34914.2 Burden of Functional Disorders 35014.3 Impact on Patients and Clinicians 35014.4 Ethnicity and Culture 35014.5 When Is it Organic Disease? 35114.6 Maintaining Factors 35214.7 Disorders of Gut-Brain Interaction (DGBI) 35214.8 The Gut-Brain Axis 35414.9 Irritable Bowel Syndrome (IBS) 35714.10 Functional Dyspepsia 35914.11 Functional Cardiovascular Symptoms 36114.12 Functional Respiratory Symptoms 36314.13 Functional Neurological Disorder (FND) 36614.14 Fibromyalgia 36914.15 Patient-Doctor Communication and Functional Symptoms 371References 37315 Bedside Teaching 379Teaching About Symptoms and Diseases 37915.1 Settings 37915.2 Bedside Teaching 38015.3 Organising Bedside Teaching 38115.4 Marrying Process and Content 38415.5 Teachable Moments 38815.6 Topics for Reflecting on the History 38915.7 Case-Based Discussion 394References 394Glossary of Terms 397Index 401