Effective History Taking in Medical Consultations

Role of a good history in diagnosing a patient

Over 80% of the diagnosis comes from the patient's history. Without it, even extensive medical knowledge won't reveal much about the patient.

History taking

History taking is an art that requires lifelong refinement.

Calgary Cambridge Model of Consultation

The model used for medical consultations in the course.

Components of taking a patient's history

The history includes: Introduction, Rapport and approach to questions, Demographics, Presenting complaint, History of presenting complaint, Past medical history, Medication history, Family history, Social history, Review of systems, Summary.

Introducing yourself during a medical interview

Introduce yourself: 'My name is [Your Name].' State who you are: 'I am a [Your role].' Ask for the patient's name: 'Can I ask what your name is?' Explain why you're there: 'Would you mind if I talk to you a bit about why you are here?'

Rapport

Rapport is a harmonious relationship characterized by mutual understanding and empathy. It can be established through: Verbal: Greeting, introduction, consent, open questions, appropriate language, and tone. Non-verbal: Handshake, eye contact, posture, and ensuring the patient is comfortable.

Open, probing, and closed questions

Open questions: Allow the patient to express their knowledge, opinion, or feelings (e.g., 'What brought you here?'). Probing questions: Build on something the patient has said (e.g., 'Tell me more about that'). Closed questions: Elicit short, factual answers (e.g., 'Where is the pain?').

Structure for asking about a patient's pain

Use the SOCRATES method: S = Site, O = Onset, C = Character, R = Radiation, A = Associated features, T = Timing, E = Exacerbating/alleviating factors, S = Severity.

Past medical/surgical history

Ask about any previous medical conditions, hospitalizations, surgeries, and regular check-ups with their GP.

Medication history

Inquire about: Prescribed medications, over-the-counter drugs, and recreational drugs. Any allergies and specific reactions to medications. Frequency, dosage, method of administration (oral, injection, etc.), and compliance.

Gathering family history

Ask about major illnesses in the family, age at death, causes of death, and any relevant hereditary conditions (e.g., hypertension, heart disease).

Importance of social history

It provides context to the patient's illness, which can influence the treatment plan. It includes questions about living circumstances, occupation, travel history, smoking, alcohol use, and hobbies.

Approaching smoking in social history

Ask in a non-judgmental way: 'Have you ever smoked?' 'For how long did you smoke?' 'How many cigarettes did you smoke per day on average?' Calculate pack years: 1 pack year = 20 cigarettes/day for 1 year.

Review of systems

The review covers different systems: Cardiovascular: Chest pain, shortness of breath, palpitations. Respiratory: Cough, wheeze, hemoptysis. Gastrointestinal: Vomiting, diarrhea, abdominal pain, weight loss. Neurological: Headache, dizziness, numbness. Genitourinary: Painful urination, blood in urine, discharge. Musculoskeletal: Joint pain, stiffness, rashes. Endocrine: Neck swelling, intolerance to heat/cold, fatigue.

Concluding a medical interview

Summarize the key points of the history and thank the patient.

Key phases of the Calgary Cambridge model of consultation

Phase 1: Initiating the session. Phase 2: Gathering information. Phase 5: Closing the session.

Preparation before a medical interview skills lab

Prepare by reading pre-lab material, reviewing the allocated scenario, practicing questions, and arriving early.