Today brought a patient with a not so unusual complaint to the office.  As is my usual approach, I let her tell me about it with as little interruption as possible.  The goal is to permit someone to tell their own story and to prompt only for details, nuances...I follow a scheme learned at the bedside 20 years ago from a "master" clinician...1) "Quality"- have the patient flesh out the nature and experience of the symptom,  2) "quantity" - How often, for how long, continuous or not? - 3) Bodily location- (patient defined, and confirm with physical findings) 4) Setting - when are the symptoms noted, when not,  what else is going on? 5)Chronology - How have symptoms progressed/changed  over time  6) Aggravating/alleviating factors? Anything that seems to help? anything that seems to make things worse 7) Associated manifestations? What else seems to be associated are there any other symptoms anywhere else?

Obviously very free form - very unstructured.  That approach still works brilliantly - I would NEVER have been able to definitively diagnose my patients clear endocrinological problem from her presenting neurological complaint had I been constrained to use a template based on the "Chief Complaint"....I'd be doing way too much talking - asking entirely wrong questions, and she'd have likely left the office for a non-needed radiologic procedure that would have failed to yield a diagnosis and been a waste of her time and money.  Instead she left the office with clear knowledge of what was wrong and a treatment plan.

Explain to me why templates are an improvement if they fail to yield a diagnosis?  If I am to use one then someone has to write one that is superior to my current ability to define the nature of the patient's problem.  So far I have been entirely underwhelmed.