Abstract：
Accurate diagnosis and treatment depend upon detailed knowledge of both the child\'s presenting symptoms and their past medical history. However, the process of soliciting past medical history has never been subject to systematic scrutiny in actual clinical practice.
OBJECTIVE: To examine the function of the question \"are you otherwise fit and well?\" to elicit a child\'s general medical history in UK paediatric allergy outpatient consultations.
METHODS: Examination of 30 video-recorded UK paediatric outpatient consultations involving children (2-10 years), caregivers, and one doctor. We identified, transcribed, and interrogated 13 examples, deploying the systematic and rigorous method of conversation analysis to elucidate the question\'s micro-design elements and their consequences for the consultation\'s trajectory.
RESULTS: Asking \"Are you otherwise fit and well?\" is built to efficiently solicit a problem-free report of good health. Nonetheless patients can and do raise other relevant matters. In practice, the question initiates several interactional matters simultaneously: establishing/resolving (mis)understandings of \"fitness\" and \"wellness\"; negotiating opportunities for children\'s participation; and importantly, a shift towards discussing more general wellbeing.
CONCLUSIONS: Past medical history questions unavoidably generate broader interactional matters which are skilfully resolved in real-time between clinicians, caregivers, and children.
CONCLUSIONS: Clinical training could be greatly enhanced by integrating insights into the interactional consequences of asking questions, particularly in the complex multiparty environment of paediatrics. While the question \'Are you otherwise fit and well\' clearly serves an important function, clinicians should be alert to the possible problems it might raise, especially when directed towards younger children.
OBJECTIVE: To examine the function of the question \"are you otherwise fit and well?\" to elicit a child\'s general medical history in UK paediatric allergy outpatient consultations.
METHODS: Examination of 30 video-recorded UK paediatric outpatient consultations involving children (2-10 years), caregivers, and one doctor. We identified, transcribed, and interrogated 13 examples, deploying the systematic and rigorous method of conversation analysis to elucidate the question\'s micro-design elements and their consequences for the consultation\'s trajectory.
RESULTS: Asking \"Are you otherwise fit and well?\" is built to efficiently solicit a problem-free report of good health. Nonetheless patients can and do raise other relevant matters. In practice, the question initiates several interactional matters simultaneously: establishing/resolving (mis)understandings of \"fitness\" and \"wellness\"; negotiating opportunities for children\'s participation; and importantly, a shift towards discussing more general wellbeing.
CONCLUSIONS: Past medical history questions unavoidably generate broader interactional matters which are skilfully resolved in real-time between clinicians, caregivers, and children.
CONCLUSIONS: Clinical training could be greatly enhanced by integrating insights into the interactional consequences of asking questions, particularly in the complex multiparty environment of paediatrics. While the question \'Are you otherwise fit and well\' clearly serves an important function, clinicians should be alert to the possible problems it might raise, especially when directed towards younger children.
摘要：
准确的诊断和治疗取决于对儿童症状和过去病史的详细了解。然而,在实际的临床实践中，征求既往病史的过程从未受到过系统的审查。
目的：在英国儿科变态反应门诊会诊中，检查“你身体健康吗？”这个问题的功能，以引出儿童的一般病史。
方法：检查30个视频记录的英国儿科门诊咨询，涉及儿童（2-10岁），看护者,还有一个医生.我们确定,转录，并询问了13个例子，部署系统和严格的对话分析方法，以阐明问题的微观设计元素及其对咨询轨迹的影响。
结果：询问“你身体健康吗？”是为了有效地征求一份没有问题的健康报告。尽管如此，患者可以并且确实提出其他相关问题。在实践中,这个问题同时引发了几个相互作用的问题：建立/解决（错误）对“健身”和“健康”的理解；谈判儿童参与的机会；重要的是，转向讨论更普遍的福祉。
结论：过去的病史问题不可避免地产生更广泛的互动问题，这些问题在临床医生之间实时巧妙地解决，看护者,还有孩子.
结论：通过将见解整合到提问的互动后果中，可以大大增强临床培训，特别是在儿科复杂的多方环境中。虽然“你是否健康”这个问题显然起到了重要的作用，临床医生应该警惕它可能引发的问题，尤其是针对年幼的孩子。
目的：在英国儿科变态反应门诊会诊中，检查“你身体健康吗？”这个问题的功能，以引出儿童的一般病史。
方法：检查30个视频记录的英国儿科门诊咨询，涉及儿童（2-10岁），看护者,还有一个医生.我们确定,转录，并询问了13个例子，部署系统和严格的对话分析方法，以阐明问题的微观设计元素及其对咨询轨迹的影响。
结果：询问“你身体健康吗？”是为了有效地征求一份没有问题的健康报告。尽管如此，患者可以并且确实提出其他相关问题。在实践中,这个问题同时引发了几个相互作用的问题：建立/解决（错误）对“健身”和“健康”的理解；谈判儿童参与的机会；重要的是，转向讨论更普遍的福祉。
结论：过去的病史问题不可避免地产生更广泛的互动问题，这些问题在临床医生之间实时巧妙地解决，看护者,还有孩子.
结论：通过将见解整合到提问的互动后果中，可以大大增强临床培训，特别是在儿科复杂的多方环境中。虽然“你是否健康”这个问题显然起到了重要的作用，临床医生应该警惕它可能引发的问题，尤其是针对年幼的孩子。
