Special Challenges in Obtaining Patient History

How should you handle a patient who is silent during history taking?

Be patient, consider using close-ended yes/no questions, look for visual or nonverbal clues, and continue assessing to find a way to communicate. Silence may provide clues to the chief complaint.

How should you handle an overly talkative patient?

Allow them to express themselves, then keep the patient focused on the questions, prioritize sticking to facts, and clarify statements to ensure accurate information. Possible causes include caffeine, nervousness, stimulant use, or underlying psychological issues.

How should multiple symptoms be addressed in patient history?

Prioritize complaints as in triage, starting with the most serious. Ask for additional information, keep an open mind, and do not focus solely on one complaint when forming a treatment plan.

How should anxiety in a patient be assessed and managed?

Recognize it may indicate a serious medical condition or psychologic shock. Observe verbal and nonverbal clues, rule out life-threatening causes (low blood glucose, shock, hypoxia), reassure the patient, and maintain confidence and a positive demeanor.

How should anger and hostility be managed during an emergency call?

Do not take anger personally, remain calm, reassuring, and gentle. Observe nonverbal cues, ensure scene safety, and retreat if the scene is unsafe. Be aware that objects within reach could be used as weapons.

How should intoxicated patients be handled during assessment?

Recognize that information may be unreliable, avoid making the patient feel threatened, and remain accepting, diplomatic, objective, and nonjudgmental. Be aware that alcohol dulls senses and may hinder reporting of pain.

How should you respond to a crying patient?

Remember that a crying patient is breathing. Be calm, patient, reassuring, confident, and use a soft voice. Additional verbal support may be necessary in extreme cases.

What are common symptoms of depression in patients?

Sadness, hopelessness, restlessness, irritability, sleeping and eating disorders, and decreased energy level. Be nonjudgmental, compassionate, and a good listener.

How should confusing behavior or history be approached in patients?

Consider hypoxia as a cause. Verify the patient’s normal mental status and do not assume confusion is due to age-related conditions like dementia or Alzheimer’s. After life threats are addressed, reask about the chief complaint or get information from someone close to the patient.

How should patients with limited cognitive abilities be handled during history taking?

Keep questions simple, limit medical terms, watch for partial answers, and rely on family, caregivers, or friends for additional information if cognitive function is severely limited.

How can cultural challenges be addressed in patient history taking?

Understand the patient’s culture and background, seek assistance from friends or family, and enlist healthcare providers of the same culture when possible.

How should language barriers be managed?

Use interpreters, translation resources, or apps. Determine if the patient understands English, introduce yourself, keep questions brief, use hand gestures, and provide advance notice to the hospital. Family and friends may temporarily interpret in emergencies.

How should you communicate with a patient who has hearing problems?

Speak slowly and clearly, use a stethoscope as a hearing aid, change the pitch of your voice, encourage lip reading, ensure hearing aids are used, learn simple sign language, or write simple yes/no questions.

How should you communicate with a visually impaired patient?

Verbally identify yourself on entering, return moved items to their original position, explain each step of assessment and vital signs checks, and notify the patient before lifting or moving them on a stretcher.