The Person Before the Patient: The Importance of a Good History

To improve patient outcomes, the multidisciplinary team not only needs to focus on the clinical management of the critically unwell patient but also importantly needs to understand the person before the patient. This is essential to ensure we are always aiming towards returning the person back to their previous lives, as physically, emotionally and psychologically well as possible. This is not a new concept and was highlighted by Dr. William Osler in 1892 who wrote that it is much more important to know what sort of a patient has a disease than what sort of a disease a patient has. It is important that we understand the patient as an individual, taking into account simple things such as previous function, family network, their likes and dislikes. It is all too easy to focus on the technical aspects of the Intensive Care Unit (ICU), but this does not attend to the human needs of the patient in relation to their psychological, social and spiritual requirements. A detailed holistic history allows clinicians to deliver patient-centred, compassionate care and establish jointly agreed goals, focusing on what is important for the patient in collaboration with their family.