The art of History Taking...
...or is it a science ? They say medicine is both an art and a science. Hell forget it - I like to keep it logical and simple so that it works for me when I need it. We can't really have mnemonics for everything on the USMLE clinical skills assessment, but we sure can have protocols...
Step 1: SP tells you his/her chief complaints,
Step 2 : O.D.P + Details ..yeah that's right ! Ask about the Onset, Duration and Progress for each of the above complaints, followed by complete details about the complaint - for example, LIQOR AAA for pain; severity, pattern, chills/rigors for fever, quality, sputum, hemoptysis for cough etc.
Step 3 : Spefic Data-Collection for the case - If you have a specific Data-Collection mnemonic for the case - NOW IS THE TIME - for e.g. FACE SLIPS for Depression / Fatigue case.
Step 4 : History of all other symptoms that are possible for the system that is involved, which were not covered in Step 3 . Keep this handy - like cough, dyspnea, chest pain, wheezing, etc. are all symptoms possible in a respiratory case.
Step 5 : History of possible complications - if any
Now move on to 'PAMHUGS FOSS SODA'
Again this is guideline for those who are not confident about their history taking styles. But I do stress the importance of memorizing D/Ds and Data-Collection for each symptom complex - that makes asking the right questions during history taking get easy.
This approach rocks especially for those times when we suffer an idiopathic mental black out in front of the SP !! ;-)
To see the above approach in action - Look up the explanation for Heel Pain case on this blog: Click here
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Labels: History taking
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