History

Question 1

What is the first thing you do?

Answer 1

1. Wash hands
2. Introduce self, including role and confirm identity
3. Seek Permission

Question 2

What is the process of the introduction?

Answer 2

1. Name - My name is Jessica Brown
2. Position - I’m a second year medical student.
3. Task - I was wondering if I could speak with you about why you have come to hospital.
4. Purpose - This is to help me learn to be a better doctor by talking with patients
5. Reassurance of care - You will still be seen by the doctor. This is only for my learning.
6. Confirmation of consent - Everything we talk about is confidential within your healthcare team.
7. Confirm Identity – can I just check your full name and DOB?
8. How would you like me to address you?

Question 3

What is the second thing you do after you introduction?

Answer 3

1. Ask about presenting complaint

- Why has the patient attended today? /reason for the attendance?

Question 4

What do you do after asking about the presenting complaint?

Answer 4

1. History of presenting complaint

- Whn did it start/has it happened before

Question 5

What can you use to explore symptoms?

Answer 5

TED
• “Ok, so tell me more about that”
• “Can you explain what that pain was like?”
• “Can you describe that for me?

Question 6

What should you ask in the history of the presenting complaint?

Answer 6

1. Investigations (have they had previous investigations? 2. Do they have an expectation regarding investigations?)
2. Assess the patient’s knowledge of treatment (have they received treatment? Did it help ? Do they have an expectation regarding treatment?)

Question 7

What is important to remember with history taking?

Answer 7

1. Open qs
2. Let patient talk
3. Clarify terms
4. Patient perspective
5. Summarise

Question 8

How can you ask and characterise pain and symptoms?

Answer 8

1. S - site
2. O - onset: gradual/ sudden/ intermittent
3. C - character: sharp /dull /stabbing /tingling /abnormal sensation
4. R - radiation: does it spread: is it dermatomal? Is it suggestive of a specific pattern?
5. A - associated symptoms: nausea / vommiting / neurological weakness / shortness of breath
6. T - time: how long
7. E - exacerbating /reliving factors what makes it better or worse? What have they tried?
8. S - severity: score pain 0-10 (no pain and 10 worst pain imaginable) or exercise tolerance

Question 9

How should you find out the patients perspective?

Answer 9

• Affect on daily life
• -the ideas the patient has about the problem (‘What thoughts have you had about what may be the cause’?)
• Any concerns / worries they have (‘What worries you about this’? OR if you think the patient looks worried, acknowledge and express that ‘You seem concerned about this’?
• Any expectations / what they hope may happen

Question 10

What should you ask in past medical history?

Answer 10

1. Previous surgery
2. Previous major illnesses or hospital admissions
3. Anything you see your GP about regularly?
4. Anything you see your specialist about regularly?
5. Any Mental Health problems?
6. Serious illnesses beginning in childhood
7. Immunisations
8. Screening Procedures

Question 11

What should you do after you have established any medical history?

Answer 11

consider whether you need any further information to understand the severity

e. g.
- COPD: ‘have you ever been admitted to ITU with your COPD / needed NIV / have at home nebulisers or oxygen?’.
- Inflammatory Bowel Disease: ‘how often do you have a flare up?’
- Mental Health: ‘have you ever been admitted to hospital for your mental health’?

Question 12

How do you ask about drug history?

Answer 12

1. Current medication
   what drug, what dose, what for, effect? Side effects? Compliance?
2. Allergies – specify the reaction
3. Contraceptives
4. Non-prescribed drugs – over the counter / recreational / herbal supplements
5. Non-oral
6. Medications that are taken as required should be enquired of further to help determine the disease severity.

Question 13

How do you ask about social history?

Answer 13

1. Alcohol – quantify (typical day typical week)
2. Smoking – quantify (pack years)
3. Vaping?
4. Recreational drugs– if not in DH
5. Diet (typical day)
6. Sleep
7. Exercise / regular activity
8. Relationships / Marital status
9. Sexual History ( if relevant to presenting complaint)
10. Work – do they work ?
11. Do they have a Carer role?
12. Recent travel
13. Any significant life events or challenges
14. Care / support at home if relevant – activities of daily living, house accessibility, stairs etc.

Question 14

How should you enquire further to help determine disease severity with medications that are taken as required?

Answer 14

1. Blue inhaler for asthma (salbutamol): ‘How often do you need it?’ The response is typically ’only when I need it’ OR ‘not very often’.
2. It can be helpful to quantify this for the patient – example – ‘How often do you need it, is it, every day, every week, only when you exercise?’
3. ‘I cant remember last time I used it, only in the winter months’.
4. Steriods: ‘How often do you need the course of steroids’? OR ‘Are they long term steroids?’ ‘Are they on a year long course that is being slowly decreased?’

Question 15

What is important to remember when asking about past medical history?

Answer 15

1. Consider how you ask these questions
2. Asking about medical problems, can often lead to patients saying “no” (as they don’t regard the condition as a problem), or “just the usual”.
3. It is also helpful to specifically enquire about any mental health conditions as these often aren’t volunteered.
4. It may be useful to ask specifically about any history of Diabetes, Hypertension, TB, cardiac or respiratory disease as a screen

Question 16

How should you ask about family history?

Answer 16

1. ‘Sometimes it can be helpful to have a broader sense of the health and wellbeing of people in your family. Is it ok if I ask you some questions about their health?’
2. ‘Do you know of any illnesses or health conditions that run in the family?’

Question 17

What are some more specific family history questions to ask once you have opened the subject?

Answer 17

1. ‘Do you know if any of your relatives had heart problems?’ ‘E.g. Diabetes?’
2. ‘Do you know if any of your relatives have had cancer?’
   - You may want to enquire about specific cancers. #Any history of bowel / breast / ovarian cancer?’
   - If the patient has a positive family history it is important to determine
3. Age at which their relative was diagnosed
4. Age, health, and cause of death, if known, of parents, siblings, children;
5. Consider drawing a pedigree / family tree if relevant

Question 18

Why is a summary important?

Answer 18

▸ Repeat back what the patient has said
▸ Gives you time to consolidate the information in your head, whilst you consider different diagnosis
▸ Can trigger other specific/clarifying questions you want to ask
▸ Patient can correct or confirm your understanding
▸ Give the key points / key negatives – you don’t need to recap all of the system review
▸ The summary gives you opportunity to ask ‘is there anything else?’ and thank the patient

Question 19

What is an overview of taking history?

Answer 19

1. Introduction
2. Presenting complaint / past
3. Charcterise pain and symptoms
4. How this affects patents / what they want
5. Past medical history
6. Drug history + allergies
7. Social history/lifestyle
8. Family history
9. Summary