The problem
Clinical histories are essential, but retrospective accounts can be affected by errors in comprehension, recall, evaluation, and communication. Recall becomes especially difficult when experiences are episodic, timing is imprecise, or the reporting period grows longer.
Why contemporaneous capture
Diary and ambulatory methods reduce the time between an experience and its documentation. Research on patient-reported outcomes describes short recall windows and reports made close to real time as useful ways to reduce reliance on increasingly fuzzy episodic memory.
Prospective symptom diaries and retrospective questionnaires do not always agree. Studies in headache and bowel symptoms, among other areas, illustrate that later summaries can differ from records collected closer to the event.
Why a structured pre-visit record
Electronic pre-visit questionnaires have been studied as tools for collecting interim history, visit goals, and patient priorities before the clinical encounter. These systems are not identical to When Did It Start?, but they support the broader idea that structured patient preparation can improve the information available for a visit.
The project’s design inference
Move the collection point closer to the event, reduce the burden of free recall, preserve uncertainty, and return the record to the person who created it.
The current design uses short questions, predefined choices, optional clarification, source labels for measurements, and an ordered timeline. It deliberately avoids diagnosis and care recommendations so that documentation remains the primary function.
Original concept paper
When Did It Start? A Design Rationale for Contemporaneous Symptom-History Capture
Author: Nick Madison
Status: Original project report in preparation.
The report will define the intervention point, information model, privacy architecture, question-battery rationale, limitations, and a proposed validation program.
What must be studied next
- Whether users can complete the battery while symptomatic without undue burden.
- Whether the generated timeline is understandable and useful to users and clinicians.
- Whether structured contemporaneous capture improves completeness or temporal accuracy compared with ordinary retrospective recall.
- Whether safety language is clear without turning the tool into an unvalidated triage system.
- Whether the question choices work across ages, disabilities, literacy levels, cultures, and languages.
- Whether free-text minimization improves usability without omitting important information.
Selected scientific support
- Redelmeier DA. Problems for clinical judgement: obtaining a reliable past medical history. Canadian Medical Association Journal. 2001. Read the paper.
- Schneider S, Stone AA. Ambulatory and diary methods can facilitate the measurement of patient-reported outcomes. Quality of Life Research. 2016. Read the paper.
- Miller VE, et al. Comparing prospective headache diary and retrospective questionnaire reports. Read the paper.
- Hudgi A, et al. Accuracy of patient-reported bowel symptoms compared with prospective records. 2023. Read the paper.
- Shucard H, et al. Clinical use of an electronic pre-visit questionnaire. 2022. Read the abstract.
- Kumah-Crystal YA, et al. Before-Visit Questionnaire: a tool to augment communication and improve documentation. 2021. Read the abstract.
- Peasgood T, et al. Systematic review of one-day versus seven-day patient-reported recall periods. 2023. Read the paper.