Medical history
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Medical History. Dr.H.N.Sarker MBBS. FCPS (med). MACP(USA). MRCP (London). MRCPS(GLASGO) Associate professor Medicine. “Patient suffers from disease but presents with symptoms” Dr.Sarker. Cardiorespiratory. Chest pain Intermittent claudication Palpitation Ankle swelling

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Medical history

Medical History

Dr.H.N.Sarker

MBBS. FCPS (med). MACP(USA).

MRCP (London). MRCPS(GLASGO)

Associate professor

Medicine



Cardiorespiratory
Cardiorespiratory symptoms”

  • Chest pain

  • Intermittent claudication

  • Palpitation

  • Ankle swelling

  • Orthopnoea


Cardiorespiratory1
Cardiorespiratory symptoms”

  • Nocturnal dyspnoea

  • Shortness of breath

  • Cough with or without sputum

  • Haemoptysis


Gastrointestinal
Gastrointestinal symptoms”

  • Abdominal pain

  • Dyspepsia

  • Dysphagia

  • Nausea and/or vomiting

  • Change in appetite


Gastrointestinal1
Gastrointestinal symptoms”

  • Weight loss or gain

  • Bowel pattern and any change

  • Rectal bleeding

  • Jaundice


Genitourinary
Genitourinary symptoms”

  • Haematuria

  • Nocturia

  • Frequency

  • Dysuria

  • Menstrual irregularity - women

  • Urethral discharge - men


Locomotor
Locomotor symptoms”

  • Joint pain

  • Joint swelling

  • Change in mobility


Neurological
Neurological symptoms”

  • Seizures

  • Collapse or blackouts

  • Dizziness and loss of balance

  • Vision

  • Hearing

  • Transient loss of function (vision, speech, sight)


Neurological1
Neurological symptoms”

  • Paraesthesiae

  • Weakness

  • Wasting

  • Spasms and involuntary movements

  • Pain in limbs and back

  • Headache


Traditional history taking model
Traditional history-taking model symptoms”

  • Presenting complaint

  • History of presenting complaint

  • Past medical history

  • Drug history-Allergy history

  • Family history

  • Social history

  • Systems review



Initiating the session
Initiating the session symptoms”

  • Begin by greeting the patient and obtaining their name.

  • Introduce yourself, your role, and the nature of the interview.

  • If appropriate, obtain verbal consent for the interview.


Medical history

  • Communication skills in the medical interview symptoms”

    Open questions allow patients to express their own thoughts and feelings, e.g. 'How have you been since we last saw you?', 'Is there anything else that you want to mention?'

    Closed questions are requests for factual information, e.g. 'When did this pain start?'

    Leading questions invite specific responses and suggest options, e.g. 'You'll be glad when this treatment is over, won't you?'


Medical history

  • Reflecting questions symptoms” help to develop or expand topics, e.g. 'Can you tell me more about your family?'

  • Active listening encourages further dialogue, e.g. 'Go on,' 'I see,' 'Hmm' etc.

  • Requesting clarification encourages further detail, e.g. 'How do mean?', 'In what way?' etc.

  • Summarising ensures accurate understanding, e.g. 'Tell me if I've got this right.'


Gathering information
Gathering information symptoms”

  • Encourage the patient to tell the story in their own words, from beginning to end.

  • Use open questioning initially; Tell me how your symptoms started?.

  • Move on to use closed questions for details.


Open and closed questions
Open and closed questions symptoms”

Both types of question have their place.

  • Can we start with you telling me what has happened to bring you into hospital? (Opening)

  • Well, I've been getting this funny feeling in my chest over the last few months. It's been getting worse and worse but it was really awful this morning. I got really breathless and felt someone was crushing me.


Open and closed questions1
Open and closed questions symptoms”

  • Tell me a bit more about the crushing feeling. (Open questioning)

  • Well, it was here, across my chest. It was sort of tight.

  • And did it go anywhere else? (Clarifying)

  • No. Well, may be up here in my neck.


Open and closed questions2
Open and closed questions symptoms”

  • So what you are saying is that you had this tight pain in your chest this morning that went on a long time and you felt it in your neck? (Summarizing) . You said you've had the pain for the last few months. Can you tell me more? (Reflecting and open questioning)

  • Well, it was the same but not that bad, though it's been getting worse recently.


Open and closed questions3
Open and closed questions symptoms”

  • Can you remember when it first started? (Clarifying)

  • Oh, 3 or 4 months ago.

  • Does anything make it worse? (Open questioning)

  • Well, if I go up steps or up hills that can bring it on.

  • What do you do?

  • Stop and sometimes take my puffer.

  • Your what? (Clarifying)

  • This spray the doctor gave me to put in my mouth.


Medical history

  • Can you show me it, please? symptoms”

  • OK.

  • And what does it do? (Clarifying)

  • Well, it takes the pain away, but I get an awful headache with it.


Open and closed questions4
Open and closed questions symptoms”

  • So, for a few months you've had this tightness in your chest, which gets worse going up hills and upstairs and which goes away if you use your spray. But today it came on and lasted longer but felt the same. Have I got that right? (Summarizing)

  • No, it was much worse this morning.


Medical history

  • Past medical history symptoms”

  • Drug history-Allergy history

  • Family history

  • Social history

  • Systems review


Medical history

THANK YOU symptoms”