Tanzania history

The name "Tanzania" was createdas aclipped compound of the namesof the twostates thatunified tocreate the country: Tanganyikaand Zanzibar . [23]
The name "Tanganyika" is derived from the Swahili words tanga ("sail") and nyika ("uninhabited plain", "wilderness"), creating the phrase "sail in the wilderness". It is sometimes understood as areference to Lake Tanganyika . [24]
The name of Zanzibar comes from "zengi", the namefor a local people(said tomean "black"), and the Arabic word "barr", whichmeanscoast or shore. [25]
History
Main articles: Historyof Tanzania andHistory ofZanzibar
A 1.8 million year-old stone chopping tool discovered at Olduvai Gorge andcurrently on displayat the BritishMuseum
Pre-colonial
The indigenous populations of easternAfrica are thoughtto bethe clickspeaking Hadza and Sandawe hunter-gatherers of Tanzania. [17] :page 17
The first waveof migration was by SouthernCushitic speakers who moved south from Ethiopia intoTanzania. Theyare ancestral tothe Iraqw ,Gorowa , and Burunge . [17] :page 17 Based on linguistic evidence, there may also have been two movementsinto Tanzania of Eastern Cushitic peopleat about 4,000 and 2,000 years ago, originating from north of Lake Turkana . [17] :pages 17–18
Archaeologicalevidence supports theconclusionthat SouthernNilotes ,including the Datoog , movedsouth from the present-day SouthSudan / Ethiopiaborder region into central northern Tanzania between 2,900and 2,400 years ago. [17] :page 18
These movementstook place at approximatelythe same timeas thesettlementof the iron-making Mashariki Bantu from WestAfrica inthe Lake Victoriaand Lake Tanganyika areas. They brought with them thewest African planting tradition and theprimary staple of yams .They subsequentlymigrated outof these regions acrosstherest of Tanzania between 2,300 and 1,700 years ago. [17][18]
Eastern Nilotic peoples, including the Maasai , represent a morerecent migration from presentday SouthSudan within thepast 500to1,500 years. [17][26]
The people of Tanzania have been associated with the productionof iron and steel. The Pare peoplewere themain producers of highly demanded ironfor peopleswho occupied themountain regions of north- easternTanzania. [27] The Hayapeople on the western shores of Lake Victoria inventedatype of high-heat blastfurnace , whichallowed them to forge carbon steel at temperatures exceeding 1,820 °C (3,310 °F) morethan 1,500years ago. [28]
Travelersand merchants from thePersian Gulfand India havevisited theeast African coast since earlyin thefirst millenniumA.D. [29] Islam was practiced by some on the Swahili Coast as early as the eighthorninth century A.D. [30]
Colonial
A 1572 depiction ofthe cityof Kilwa ,a UNESCOWorldHeritage Site
Claimingthecoastal strip, OmaniSultan Said bin Sultan movedhiscapital to Zanzibar Cityin 1840. Duringthis time, Zanzibar became thecentre forthe Arab slavetrade . [31]
Between65and 90percentof theArab- Swahili population of Zanzibar was enslaved. [32]
One of the most infamous slavetraders on theEast African coast was TippuTip , who was thegrandsonof an enslaved African. The Nyamwezi slave traders operatedunder the leadership of Msiri and Mirambo . [33]
According toTimothy Insoll , "Figures recordthe exporting of 718,000 slavesfrom the Swahili coast duringthe19th century,and theretention of 769,000on thecoast." [34] In the1890s, slavery was abolished. [35]
Maji Maji Rebellionagainst German colonial rulein 1905
Inthe late 19th century, Germanyconquered the regions thatare now Tanzania (minus Zanzibar) and incorporated them into German EastAfrica (GEA). [ citation needed ]The Supreme Council of the1919 Paris Peace Conference awarded all of GEAto Britain on 7May 1919, over the strenuous objectionsof Belgium. [36] :240 The British colonial secretary , Alfred Milner ,and Belgium's minister plenipotentiarytothe conference, PierreOrts , then negotiatedthe Anglo-Belgian agreement of 30May 1919 [37]
:618-9 where Britain cededthe north-western GEA provinces of Ruandaand Urundito Belgium. [36] :246 The conference's Commission on Mandates ratified this agreement on 16 July1919. [36]
:246-7 The Supreme Council accepted theagreement on 7 August1919. [37] :612-3 On 12 July1919, theCommission on Mandates agreed thatthe smallKionga Triangle south of theRovuma River would be giventoPortuguese Mozambique , [36] :243 with it eventually becomingpart of independent Mozambique .The commission reasonedthat Germanyhad virtually forced Portugal to cede thetriangle in1894. [36] :243 The Treaty of Versailles was signed on 28 July1919, althoughthe treaty did nottake effect until 10 January 1920.On thatdate, theGEAwas transferred officially toBritain, Belgium, and Portugal. Alsoon that date, "Tanganyika" became thename of the British territory.
DuringWorld War II , about 100,000people from Tanganyikajoined theAllied forces [38] and were among the 375,000Africans who fought with those forces. [39]
Tanganyikans fought in units of the King's African Rifles duringtheEast African Campaignin Somalia and Abyssinia against theItalians, inMadagascar againstthe Vichy French duringthe MadagascarCampaign , and in Burmaagainst theJapanese duringtheBurma Campaign . [39] Tanganyikawas animportant source of food duringthis war, and its export income increased greatly compared tothepre-war years of the Great Depression [38]
Wartime demand, however, caused increased commodity prices and massive inflation withinthe colony. [40]
In 1954, Julius Nyerere transformed anorganisation into thepolitically oriented TanganyikaAfrican National Union (TANU). TANU's main objective was toachieve national sovereignty for Tanganyika.A campaign to registernew members was launched, and within ayear, TANUhad become theleading political organisation inthe country. Nyerere became Minister of British- administeredTanganyikain 1960and continued as prime minister when Tanganyika becameindependent in 1961. [ citation needed ]
Post-colonial
Britishrule came toanend on December9, 1961,but forthe firstyear of independence, Tanganyikahad agovernor general who represented the Britishmonarch. [41] :page 6 On9 December1962, Tanganyika becamea democraticrepublic under anexecutive president. [41] :page 6
After the Zanzibar Revolution overthrew theArab dynasty in neighbouringZanzibar , [42]
whichhad become independent in1963, the archipelago merged with mainland Tanganyika on 26 April1964. [43] On29 October of the sameyear, thecountry was renamed theUnited Republic of Tanzania ("Tan" comes from Tanganyikaand "Zan" from Zanzibar). [14] The union of thetwo hitherto separate regions was controversial among many Zanzibaris (even those sympathetic totherevolution) butwas accepted byboth the Nyereregovernment and the RevolutionaryGovernment of Zanzibar owing toshared political values and goals.
Following Tanganyika's independenceand unification with Zanzibar leadingto the state of Tanzania, President Nyerereemphasized aneed to construct anational identity forthe citizensof the new country. To achieve this, Nyerereprovided what is regarded as one of the most successful cases of ethnic repression and identity transformationin Africa. [44]
With over 130languages spokenwithin its territory, Tanzania isoneof themost ethnically diverse countries in Africa. Despitethis obstacle, ethnicdivisions remained rare inTanzania when compared to therestof thecontinent, notably its immediate neighbor, Kenya. Furthermore, since its independence, Tanzania has displayed more political stability than most African countries, particularly dueto Nyerere's ethnic repression methods. [45]
Arusha DeclarationMonument
In1967, Nyerere's first presidency took aturn tothe left after the Arusha Declaration , whichcodified a commitment tosocialism as well-as Pan-Africanism . After thedeclaration, banks and manylarge industrieswere nationalised.
Tanzania was also aligned with China, which from 1970 to1975financed and helped build the 1,860-kilometre-long (1,160 mi) TAZARARailway from Dares Salaamto Zambia . [46] Nonetheless, from thelate 1970s, Tanzania's economy took aturn forthe worse, in thecontext of an international economic crisis affectingboth developed and developing economies.
Fromthe mid-1980s, the regime financed itself by borrowing from the International Monetary Fund and underwent some reforms. Since then, Tanzania's gross domestic product per capita has grown and povertyhas been reduced, according toa report bytheWorld Bank. [47]
In1992, the Constitution of Tanzania was amended to allowmultiple political parties. [48] In Tanzania's first multi-party elections, held in 1995,the ruling Chama Cha Mapinduzi won 186of the232 elected seats in theNational Assembly, and Benjamin Mkapa was elected as president.

History of Present Illness (HPI

History of Present Illness (HPI)

Obtaining an accurate history is the critical first step in determining the etiology of a patient's problem. A large percentage of the time, you will actually be able to make a diagnosis based on the history alone. The value of the history, of course, will depend on your ability to elicit relevant information. Your sense of what constitutes important data will grow exponentially in the coming years as you gain a greater understanding of the pathophysiology of disease through increased exposure to patients and illness. However, you are already in possession of the tools that will enable you to obtain a good history. That is, an ability to listen and ask common-sense questions that help define the nature of a particular problem. It does not take a vast, sophisticated fund of knowledge to successfully interview a patient. In fact seasoned physicians often lose site of this important point, placing too much emphasis on the use of testing while failing to take the time to listen to their patients. Successful interviewing is for the most part dependent upon your already well developed communication skills.

What follows is a framework for approaching patient complaints in a problem oriented fashion. The patient initiates this process by describing a symptom. It falls to you to take that information and use it as a springboard for additional questioning that will help to identify the root cause of the problem. Note that this is different from trying to identify disease states which might exist yet do not generate overt symptoms. To uncover these issues requires an extensive "Review Of Systems" (a.k.a. ROS). Generally, this consists of a list of questions grouped according to organ system and designed to identify disease within that area. For example, a review of systems for respiratory illnesses would include: Do you have a cough? If so, is it productive of sputum? Do you feel short of breath when you walk? etc. In a practical sense, it is not necessary to memorize an extensive ROS question list. Rather, you will have an opportunity to learn the relevant questions that uncover organ dysfunction when you review the physical exam for each system individually. In this way, the ROS will be given some context, increasing the likelihood that you will actually remember the relevant questions.

The patient's reason for presenting to the clinician is usually referred to as the "Chief Complaint." Perhaps a less pejorative/more accurate nomenclature would be to identify this as their area of "Chief Concern."

Getting Started:
Always introduce yourself to the patient. Then try to make the environment as private and free of distractions as possible. This may be difficult depending on where the interview is taking place. The emergency room or a non-private patient room are notoriously difficult spots. Do the best that you can and feel free to be creative. If the room is crowded, it's OK to try and find alternate sites for the interview. It's also acceptable to politely ask visitors to leave so that you can have some privacy.

If possible, sit down next to the patient while conducting the interview. Remove any physical barriers that stand between yourself and the interviewee (e.g. put down the side rail so that your view of one another is unimpeded... though make sure to put it back up at the conclusion of the interview). These simple maneuvers help to put you and the patient on equal footing. Furthermore, they enhance the notion that you are completely focused on them. You can either disarm or build walls through the speech, posture and body languarge that you adopt. Recognize the power of these cues and the impact that they can have on the interview. While there is no way of creating instant intimacy and rapport, paying attention to what may seem like rather small details as well as always showing kindness and respect can go a long way towards creating an environment that will facilitate the exchange of useful information.

If the interview is being conducted in an outpatient setting, it is probably better to allow the patient to wear their own clothing while you chat with them. At the conclusion of your discussion, provide them with a gown and leave the room while they undress in preparation for the physical exam.

Initial Question(s):
Ideally, you would like to hear the patient describe the problem in their own words. Open ended questions are a good way to get the ball rolling. These include: "What brings your here? How can I help you? What seems to be the problem?" Push them to be as descriptive as possible. While it's simplest to focus on a single, dominant problem, patients occasionally identify more then one issue that they wish to address. When this occurs, explore each one individually using the strategy described below.

Follow-up Questions:
There is no single best way to question a patient. Successful interviewing requires that you avoid medical terminology and make use of a descriptive language that is familiar to them. There are several broad questions which are applicable to any complaint. These include:

1. Duration: How long has this condition lasted? Is it similar to a past problem? If so, what was done at that time?
2. Severity/Character: How bothersome is this problem? Does it interfere with your daily activities? Does it keep you up at night? Try to have them objectively rate the problem. If they are describing pain, ask them to rate it from 1 to 10 with 10 being the worse pain of their life, though first find out what that was so you know what they are using for comparison (e.g. childbirth, a broken limb, etc.). Furthermore, ask them to describe the symptom in terms with which they are already familiar. When describing pain, ask if it's like anything else that they've felt in the past. Knife-like? A sensation of pressure? A toothache? If it affects their activity level, determine to what degree this occurs. For example, if they complain of shortness of breath with walking, how many blocks can they walk? How does this compare with 6 months ago?
3. Location/Radiation: Is the symptom (e.g. pain) located in a specific place? Has this changed over time? If the symptom is not focal, does it radiate to a specific area of the body?
4. Have they tried any therapeutic maneuvers?: If so, what's made it better (or worse)?
5. Pace of illness: Is the problem getting better, worse, or staying the same? If it is changing, what has been the rate of change?
6. Are there any associated symptoms? Often times the patient notices other things that have popped up around the same time as the dominant problem. These tend to be related.
7. What do they think the problem is and/or what are they worried it might be?
8. Why today?: This is particularly relevant when a patient chooses to make mention of symptoms/complaints that appear to be long standing. Is there something new/different today as opposed to every other day when this problem has been present? Does this relate to a gradual worsening of the symptom itself? Has the patient developed a new perception of its relative importance (e.g. a friend told them they should get it checked out)? Do they have a specific agenda for the patient-provider encounter?

For those who favor mnemonics, the 8 dimensions of a medical problem can be easily recalled using OLD CARTS (Onset, Location/radiation, Duration, Character, Aggrevating factors, Reliving factors, Timing and Severity).

The content of subsequent questions will depend both on what you uncover and your knowledge base/understanding of patients and their illnesses. If, for example, the patient's initial complaint was chest pain you might have uncovered the following by using the above questions:

The pain began 1 month ago and only occurs with activity. It rapidly goes away with rest. When it does occur, it is a steady pressure focused on the center of the chest that is roughly a 5 (on a scale of 1 to 10). Over the last week, it has happened 6 times while in the first week it happened only once. The patient has never experienced anything like this previously and has not mentioned this problem to anyone else prior to meeting with you. As yet, they have employed no specific therapy.

This is quite a lot of information. However, if you were not aware that coronary-based ischemia causes a symptom complex identical to what the patient is describing, you would have no idea what further questions to ask. That's OK. With additional experience, exposure, and knowledge you will learn the appropriate settings for particular lines of questioning. When clinicians obtain a history, they are continually generating differential diagnoses in their minds, allowing the patient's answers to direct the logical use of additional questions. With each step, the list of probable diagnoses is pared down until a few likely choices are left from what was once a long list of possibilities. Perhaps an easy way to understand this would be to think of the patient problem as a Windows-Based computer program. The patient tells you a symptom. You click on this symptom and a list of general questions appears. The patient then responds to these questions. You click on these responses and... blank screen. No problem. As yet, you do not have the clinical knowledge base to know what questions to ask next. With time and experience you will be able to click on the patient's response and generate a list of additional appropriate questions. In the previous patient with chest pain, you will learn that this patient's story is very consistent with significant, symptomatic coronary artery disease. As such, you would ask follow-up questions that help to define a cardiac basis for this complaint (e.g. history of past myocardial infarctions, risk factors for coronary disease, etc.). You'd also be aware that other disease states (e.g. emphysema) might cause similar symptoms and would therefore ask questions that could lend support to these possible diagnoses (e.g. history of smoking or wheezing). At the completion of the HPI, you should have a pretty good idea as to the likely cause of a patient's problem. You may then focus your exam on the search for physical signs that would lend support to your working diagnosis and help direct you in the rational use of adjuvant testing.

Recognizing symptoms/responses that demand an urgent assessment (e.g. crushing chest pain) vs. those that can be handled in a more leisurely fashion (e.g. fatigue) will come with time and experience. All patient complaints merit careful consideration. Some, however, require time to play out, allowing them to either become "a something" (a recognizable clinical entity) or "a nothing," and simply fade away. Clinicians are constantly on the look-out for markers of underlying illness, historical points which might increase their suspicion for the existence of an underlying disease process. For example, a patient who does not usually seek medical attention yet presents with a new, specific complaint merits a particularly careful evaluation. More often, however, the challenge lies in having the discipline to continually re-consider the diagnostic possibilities in a patient with multiple, chronic complaints who presents with a variation of his/her "usual" symptom complex.

You will undoubtedly forget to ask certain questions, requiring a return visit to the patient's bedside to ask, "Just one more thing." Don't worry, this happens to everyone! You'll get more efficient with practice.

Dealing With Your Own Discomfort:
Many of you will feel uncomfortable with the patient interview. This process is, by its very nature, highly intrusive. The patient has been stripped, both literally and figuratively, of the layers that protect them from the physical and psychological probes of the outside world. Furthermore, in order to be successful, you must ask in-depth, intimate questions of a person with whom you essentially have no relationship. This is completely at odds with your normal day to day interactions. There is no way to proceed without asking questions, peering into the life of an otherwise complete stranger. This can, however, be done in a way that maintains respect for the patient's dignity and privacy. In fact, at this stage of your careers, you perhaps have an advantage over more experienced providers as you are hyper-aware that this is not a natural environment. Many physicians become immune to the sense that they are violating a patient's personal space and can thoughtlessly over step boundaries. Avoiding this is not an easy task. Listen and respond appropriately to the internal warnings that help to sculpt your normal interactions.

Biological Abstracts

Biological Abstracts

Biological Abstracts is a database produced by Clarivate Analytics. It includes abstracts from peer-reviewedacademic journal articles in the fields of biology, biochemistry, biotechnology, botany, pre-clinical and experimental medicine, pharmacology, zoology, agriculture, and veterinary medicine published since 1926.[1][2]

Biological Abstracts

Producer	Clarivate Analytics (United States)
History	1926 to present
Coverage
Disciplines	Science
Record depth	Index & abstract
Print edition
ISSN	0006-3169
Links
Website Title list

It can be accessed through number of services, including EBSCO,[3] Ovid [4] and Web of Science.[1]

History

The service began as a print publication in 1926, when it was formed by the union of Abstracts of Bacteriology (1917–25), and Botanical Abstracts (1919–26), both published in Baltimore by Williams and Wilkins.[5] It was published in paperback subject sections, with abstracts usually written by scientist in the US, as a great many of articles in that period were in other languages. At the time of founding it was in competition with the classified indexing service of the Concilium Bibliographicum in Zurich.[6]

The first online version was published on magnetic tape; it contained only the bibliographic information, not the text of the abstracts, and was intended as a rapid alerting service.

Kilimanjaro Porters

Established in 2003, the Kilimanjaro Porters Assistance Project (KPAP) is a legally registered Tanzanian not-for-profit organization. Our Mission is to improve the working conditions of the porters on Kilimanjaro. KPAP is not a porter membership organization, or a tour operating business, and we do not collect any fees from porters or climbing companies. KPAP is an initiative of the International Mountain Explorers Connection (IMEC), a 501(c)3 nonprofit organization based out of Boulder, Colorado in the United States. Promoting Socially Responsible Kilimanjaro Climbs Those who have climbed Mount Kilimanjaro know that porters are the backbone of the trek. Many climbers may not realize that porters can be ill-equipped, poorly paid and have improper working conditions. KPAP’s focus is improving the working conditions of the porters by: Lending mountain clothing to porters free of charge Advocating for fair wages and ethical treatment by all companies climbing Kilimanjaro Encouraging climbers to select a climbing company with responsible treatment practices towards their crew (insert link to Partner companies here) Providing educational opportunities to the mountain crew KPAP is a not-for-profit organization largely funded by donations from conscientious individuals in the climbing public who support responsible treatment practices. Please consider donating to allow KPAP to continue this important work. Porters on Mount Kilimanjaro Mount Kilimanjaro is a unique travel experience and a once in a lifetime adventure for tens of thousands of climbers every year. When climbing Kilimanjaro, an extensive team of mountain crew – guides, cooks and porters – provide specially trained support throughout the climb to assist you in reaching the summit. The porters, who carry all of your food and gear, are the heart and soul of your mountain experience. Without their strength, dedication and hard work, you would not be able to enjoy the magnificence of Kilimanjaro. A Kilimanjaro trek requires a significant financial commitment. The cost to climb Mount Kilimanjaro includes government park fees for the conservation of the mountain, VAT taxes, and the operational expenses to support the climb. Climbing on the cheap often means lower wages and inferior working conditions for porters. The International Mountain Explorers Connection has created the Partner for Responsible Travel Program to recognize tour operators committed to fair treatment practices of their crew. Whether you are a climber, local tour operator, travel agent, charity group, porter, cook or guide, the Kilimanjaro Porters Assistance Project needs your assistance to advocate for and safeguard the fair and ethical treatment of all porters.

Serengeti National Park

Serengeti National Park
Latest News from the Serengeti. The Wildebeest migration are now out of the
Maasai Mara and in the Serengeti National Park at the southern end of the Serengeti Ecosystem where they are giving birth to some 500,000 calfs. This i an incredible time to visit should you wish.
Serengeti National Park (Serengeti) is located in Tanzania, best known for its abundance of animals and the great wildebeest migration.
The Serengeti stretches 14,763 (5,700 sq miles) stretching North to Kenya and bordering Lake Victoria to the West.
Serengeti has the highest concentration of large mammals on this planet and its famous known for its 2,500 Lions the largest concentration found anywhere. The park also has over 518 identified bir species where some of them are Eurasian migrants who are present in th European winter months from October t April.
Accommodation: There is a wide range places to stay in the Serengeti Ecosystem. There is also a very good
Serengeti Map if you would like to know more about the general size and area.
Distance
With the Serengeti only 335 km (208 miles) from Arusha it is still a very long drive due to the roads. If you are driving to the Serengeti National Park it is recommended to stop off on the way. W would like to point out that if you are interested in visiting the Ngorongoro Crater on the way, it is best to get to the rim the afternoon before and then spend the whole next day in the Crater.
Best time to visit
Following the Wildebeest migration from Serengeti National Park to Maasai Mara National Reserve, the best time is December to July and to see the predators the best time is June to October.
Recommended number of days
Due to the amount to be seen in the reserve it’s recommendable to have thre or four day’s safari. If you are interested in photography, the longer you stay the better chances you have to get the ultimate photos.

Ahmad Tibi: Trump 'promoting anarchy' in Middle East

Ahmad Tibi, a veteran Israeli Arab MP and one time adviser to Yasser Arafat has spoken about US President Donald Trump recognising Jerusalem as Israel’s capital.

He told BBC Hardtalk's Stephen Sackur that the US president had erroneously interpreted this as "an internal issue of the Israelis" and risked "anarchy" in the region by supporting "a violation of international law".

This interview was broadcast on Wednesday 7 March 2018. You can see the programme in full on BBC iPlayer (UK only)

Protein

Protein attracts water and plays an important role in water balance. In cases of severe protein deficiency, the blood may not contain enough protein to attract water from the tissue spaces back into the capillaries. This is why starvation often shows an enlarged abdomen. The abdomen is swollen with edema or water retention caused by the lack of protein in their diet.

When the capillary walls are too permeable, protein can leak out of the blood and settle in the tissue spaces. It will then act like a magnet for water, continuously attracting more water from the blood to accumulate in the tissue spaces.^[9]

Water Medicine

The term water retention (also known as fluid retention) or hydrops, hydropsy, edema, signifies an abnormal accumulation of clear, watery fluid in the tissues or cavities of the body.^[1][2]

Water is found both inside and outside the body’s cells. It forms part of the blood, helping to carry the blood cells around the body and keeping oxygen and important nutrients in solution so that they can be taken up by tissues such as glands, bone and muscle. Even the organs and muscles are mostly water.

The body uses a complex system of hormones and hormone-like substances called prostaglandins to keep its volume of fluid at a constant level. If one were to intake an excessive amount of fluid in one day, the amount of fluid would not be affected in the long term. This is because the kidneys quickly excrete the excess in the form of urine. Likewise, if one did not get enough to drink, the body would hold on to its fluids and urinate less than usual. Imbalances in this system can lead to water retention, which can range from mild and unnoticeable to symptomatic with swelling.,

Clinical Practice

The Doctor by Sir Luke Fildes (1891)

Medical availability and clinical practice varies across the world due to regional differences in culture and technology. Modern scientific medicine is highly developed in the Western world, while in developing countries such as parts of Africa or Asia, the population may rely more heavily on traditional medicine with limited evidence and efficacy and no required formal training for practitioners.^[8] Even in the developed world however, evidence-based medicine is not universally used in clinical practice; for example, a 2007 survey of literature reviews found that about 49% of the interventions lacked sufficient evidence to support either benefit or harm.^[9]

In modern clinical practice, physicians personally assess patients in order to diagnose, treat, and prevent disease using clinical judgment. The doctor-patient relationship typically begins an interaction with an examination of the patient's medical history and medical record, followed by a medical interview^[10] and a physical examination. Basic diagnostic medical devices (e.g. stethoscope, tongue depressor) are typically used. After examination for signs and interviewing for symptoms, the doctor may order medical tests (e.g. blood tests), take a biopsy, or prescribe pharmaceutical drugs or other therapies. Differential diagnosis methods help to rule out conditions based on the information provided. During the encounter, properly informing the patient of all relevant facts is an important part of the relationship and the development of trust. The medical encounter is then documented in the medical record, which is a legal document in many jurisdictions.^[11]Follow-ups may be shorter but follow the same general procedure, and specialists follow a similar process. The diagnosis and treatment may take only a few minutes or a few weeks depending upon the complexity of the issue.

The components of the medical interview^[10] and encounter are:

• Chief complaint (CC): the reason for the current medical visit. These are the 'symptoms.' They are in the patient's own words and are recorded along with the duration of each one. Also called 'chief concern' or 'presenting complaint'.
• History of present illness (HPI): the chronological order of events of symptoms and further clarification of each symptom. Distinguishable from history of previous illness, often called past medical history (PMH). Medical history comprises HPI and PMH.
• Current activity: occupation, hobbies, what the patient actually does.
• Medications (Rx): what drugs the patient takes including prescribed, over-the-counter, and home remedies, as well as alternative and herbal medicines/herbal remedies. Allergies are also recorded.
• Past medical history (PMH/PMHx): concurrent medical problems, past hospitalizations and operations, injuries, past infectious diseases or vaccinations, history of known allergies.
• Social history (SH): birthplace, residences, marital history, social and economic status, habits (including diet, medications, tobacco, alcohol).
• Family history (FH): listing of diseases in the family that may impact the patient. A family tree is sometimes used.
• Review of systems (ROS) or systems inquiry: a set of additional questions to ask, which may be missed on HPI: a general enquiry (have you noticed any weight loss, change in sleep quality, fevers, lumps and bumps? etc.), followed by questions on the body's main organ systems (heart, lungs, digestive tract, urinary tract, etc.).

The physical examination is the examination of the patient for medical signs of disease, which are objective and observable, in contrast to symptoms which are volunteered by the patient and not necessarily objectively observable.^[12] The healthcare provider uses the senses of sight, hearing, touch, and sometimes smell (e.g., in infection, uremia, diabetic ketoacidosis). Four actions are the basis of physical examination: inspection, palpation (feel), percussion (tap to determine resonance characteristics), and auscultation (listen), generally in that order although auscultation occurs prior to percussion and palpation for abdominal assessments.^[13]

The clinical examination involves the study of:

• Vital signs including height, weight, body temperature, blood pressure, pulse, respiration rate, and hemoglobin oxygen saturation
• General appearance of the patient and specific indicators of disease (nutritional status, presence of jaundice, pallor or clubbing)
• Skin
• Head, eye, ear, nose, and throat (HEENT)
• Cardiovascular (heart and blood vessels)
• Respiratory (large airways and lungs)
• Abdomen and rectum
• Genitalia (and pregnancy if the patient is or could be pregnant)
• Musculoskeletal (including spine and extremities)
• Neurological (consciousness, awareness, brain, vision, cranial nerves, spinal cord and peripheral nerves)
• Psychiatric (orientation, mental state, evidence of abnormal perception or thought).

It is to likely focus on areas of interest highlighted in the medical history and may not include everything listed above.

The treatment plan may include ordering additional medical laboratory tests and medical imaging studies, starting therapy, referral to a specialist, or watchful observation. Follow-up may be advised. Depending upon the health insurance plan and the managed care system, various forms of "utilization review", such as prior authorization of tests, may place barriers on accessing expensive services.^[14]

The medical decision-making (MDM) process involves analysis and synthesis of all the above data to come up with a list of possible diagnoses (the differential diagnoses), along with an idea of what needs to be done to obtain a definitive diagnosis that would explain the patient's problem.

On subsequent visits, the process may be repeated in an abbreviated manner to obtain any new history, symptoms, physical findings, and lab or imaging results or specialist consultations.