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Residents and Medical Students Noting the Chief Complaint during Verbal Presentations

Marinella, Mark A. MD

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The chief complaint, the framework around which a clinician builds a focused patient history, is an important component of the verbal case presentation and should be mentioned at the beginning of the presentation.1 However, one study found that house officers omitted the chief complaint in 17% of their morning report case presentations.2 The purpose of my observational study was to note how often internal medicine house officers and medical students mentioned the chief complaint as a part of their verbal case presentations during morning team rounds.

During a one-month period in 1999, I observed internal medicine house officers and medical student clerks, noting whether or not they mentioned the chief complaint during case presentations at morning rounds on an inpatient teaching service at Miami Valley Hospital, a major teach affiliate of Wright State University School of Medicine in Dayton, Ohio. There were 55 patients over the study period (15 admitting days) who were able to give a chief complaint; patients who were intubated or unconscious upon arrival were not included. House officers presented 35 cases, noting the chief complaint in 17 (49%), and medical students presented 20 cases, noting the chief complaint in 12 (60%). There was no significant difference in the frequencies with which house officers and medical students mentioned the chief complaint (p = .414; chi-square analysis).

This study shows that internal medicine house officers and medical student clerks frequently omitted the chief complaint from verbal case presentations. As noted, on the first day of the rotation, attending physicians reviewed with students the elements of the verbal presentation, emphasizing the chief complaint. The importance of the medical history cannot be underestimated even in this day of high-technology medicine. The chief complaint helps clinicians pursue a succinct history and often aids greatly in the final diagnosis. Although my study may be limited by its small sample size, it demonstrates that educators need to reinforce the importance of the chief complaint as the cornerstone around which the medical history is built.


1. Hardison JE. Whatever happened to the chief complaint? JAMA. 1991;245:1942.
2. Sapira JD. The history. In: Sapira JD. The Art and Science of Bedside Diagnosis. Baltimore, MD: Williams and Wilkins, 1990.
© 2000 Association of American Medical Colleges