From ancient storytelling to AI chatbots, the nature of medical history-taking has changed profoundly – and it’s important not to lose sight of what really matters, writes University of Queensland researcher Anton Cush.
Anton Cush writes:
When you visit a doctor, the first question is often: “What brings you in today?”
This simple prompt has been part of medicine for a long time. But how people answer, and how health workers listen, has changed a lot.
Taking a medical history is not just about collecting facts. It is about understanding illness, building trust, and shaping the relationship between the person seeking care and the one providing it.
How it used to work
In Ancient Greece, people believed that illness came from an imbalance in four body fluids: blood, phlegm, yellow bile, and black bile.
Patients did not speak in medical terms. They described their symptoms using everyday words. Saying they felt “dry” or “hot” meant something important. Doctors paid attention and kept detailed case notes. These notes were anonymous but were meant to guide other practitioners.
In India, Ayurvedic medicine also focused on balance. It was based on three life forces: vata, pitta, and kapha. These were thought to shape health and personality.
Diagnosis included physical checks and long interviews. Patients were encouraged to speak about diet, lifestyle, sleep, and emotions. The approach was personal and holistic.
In Traditional Chinese Medicine, shaped by Confucian thought, the patient’s voice mattered deeply. Illness was seen as a disruption in the body’s energy flow or a loss of harmony between yin and yang.
Practitioners listened not just to words but also to tone, silence, and family dynamics. They believed that the full story mattered, not just the symptoms.
In all of these systems, trust was built through careful attention and ethical care. Patients were seen as whole people. Listening was a key part of diagnosis.
How it works now
Today, many people complete parts of their medical history before they even see a doctor. They might fill in a digital form, use an app, or talk to a chatbot.
Patients often arrive with a self-diagnosis after searching their symptoms online. Sometimes this helps the consultation move faster. Other times it brings confusion or incorrect information, which can delay the right treatment.
There are now many ways to track personal health. Apps monitor mood and sleep. Smartwatches record heart rate, activity, and stress. In some clinics, artificial intelligence systems collect patient history and provide summaries before the clinician sees the patient.
These tools can support efficiency. But they raise important questions.
Can a system detect pain in someone’s voice? Can a multiple-choice form understand fear, confusion, or hesitation? What happens when the first person a patient speaks to is not actually a person?
Risk of feeling unheard
Clinicians are adjusting. Many now type into electronic health records during appointments. Some use voice recognition. Others are testing digital scribes who take notes in the background.
The rise of telehealth, especially during the COVID-19 pandemic, has made things more complex. When you cannot examine someone in person, careful listening becomes even more important.
Even with these tools, one major issue remains. Patients need to feel heard.
Technology can record facts, but it does not always capture emotion or context. It might log “chest pain” but not the fear behind it. Or it might miss how long someone waited, how stressed they were, or how hard it was for them to speak clearly.
In the United States, open notes laws allow patients to read their own medical records. This has encouraged more thoughtful and transparent documentation. It has also made some clinicians more cautious.
Writing notes that are clear, accurate, and respectful has become an important communication skill.
Stories still matter
As digital systems become more common, it is easy to forget what medical history-taking is really for. It is not just about ticking boxes or speeding up the process. It is a conversation that helps build trust and understanding.
In the past, the patient’s story was often the most important diagnostic tool. Today, it usually starts a chain of tests and referrals.
But when software takes over more of the process, stories can shrink. They get squeezed into templates, checklists, and short text fields.
When people talk about their health, they are often talking about their lives. What matters to them. What they are afraid of. What they hope will happen.
If we stop listening to that, or build systems that cannot handle it, we risk losing something critical to good care.
This matters even more for people who already face barriers in the system. That includes people with low health literacy, those with disability, people from non-English-speaking backgrounds, and people without digital access.
If the tools are not built for everyone, they will not work for everyone.
Learn from the past
As we plan the future of digital healthcare, we should also look back at what earlier systems got right. Ancient traditions were not perfect, but they treated listening as a clinical act. They gave time and space to the person’s story.
Modern digital tools can help. They can support note-taking, organise information, and improve consistency.
But they must not take away the human connection. Technology should support conversations, not replace them.
Good care still depends on listening. It means listening to what is said and what is not said.
If we reduce illness to numbers and symptoms to screens, we risk forgetting the most powerful diagnostic tool we have. That tool is listening to the person behind the problem.
• Anton Cush is a PhD candidate in Digital Health at the University of Queensland. His research explores how AI tools can support communication in emergency departments, and what may be lost when human conversations are replaced by automation.
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