It is frequently said that a thousand mile journey begins with a single step and a proper diagnosis is composed of a number of steps. More and more health practitioners now believe that the first of these steps should be to determine when the unwanted symptom or condition was first noticed by the patient or the patient’s family. They want to know if anything changed that might affect the person and almost always something did change.

In some cases, if the unwanted symptoms are ones like depression, nervousness, anxiety, irritability, foggy thinking, tiredness, sleep problems, weight gain or loss or constipation, the symptoms are noticed by the patient’s family or friends before the patient. This is why it is often helpful for the patient to ask his or her family or close friends when they noticed that the patient was experiencing the unwanted symptoms or condition.

Once a time is established for the onset of the unwanted symptom or condition, the next step is to determine what may have changed in the patient’s life prior to the onset of the unwanted symptom or condition. Changes in diet, in relationships, in exercise routine, in sleep, in working conditions and in one’s environment can add critical data necessary to the correct diagnosis.

For example, if a man complains of being tired all the time and was working in an office but changed his job and started working outside in a warm climate, it is quite possible that he is dehydrated–even if he insists that he is drinking a lot of water. An improper electrolyte balance can lead to dehydration which can cause many unwanted symptoms and conditions. In this case, the practitioner knows that the patient is likely dehydrated and some practitioners will elect to immediately test for electrolyte imbalances and use IV’s to properly hydrate his body. If the problem does not resolve then more testing is necessary.

If ensuring that the person is no longer dehydrated doesn’t result in an alleviation of the symptoms, then the practitioner knows that additional tests are needed. Without knowing about the change in the patient’s life, the practitioner may have not suspected dehydration.

Another example is the woman who started to have many emotional problems after the birth of her child. The practitioner knows that during pregnancy many of the hormones that are normally produced by the woman are produced through the placenta. Once the placenta is gone, some women find that their body’s production of hormones has not returned to its pre-pregnancy level. Also, it is relatively common that after delivery of the baby, a woman may suffer from postpartum thyroiditis.

Women suffering from postpartum thyroiditis (inflammation of the thyroid) often are nervous, feel like they are having problems thinking or sleep problems. While many women recover on their own, some can continue to have thyroid problems which, if untreated, will lead to more and more problems.

These are just two examples of why it is very important to provide the data on if there were any changes in a patient’s life prior to when the symptoms and/or condition started.