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the sentence (e.g
. have, do, must, etc.)
and the subject, e.g.
The
itching doesn’t bother you at night,
does it?
Another effective question technique is the “
cone technique”
which moves from open to closed questions. It ensures that the doctor
obtains a picture of the problem from the patient’s perspective by
opening up the discussion. With the need to confirm specifics and nar-
row down the cause of symptoms, etc., the doctor then follows with
more closed questions. It is important for the doctor to become more
focused as the interview progresses, investigating specific areas that
may not emerge from the patient’s story.
A full case history usually covers:
–
personal details
– family history
–
presenting complaint
– social history
–
past medical history (PMH)
– review of system.
–
drug history
Normally,
patient’s personal details
have been entered in their
records by a nurse or administrative staff before a doctor sees them.
However, on later consultations a doctor may wish to check details
such as address, date of birth, occupation or marital status.
The presenting (or chief) complaint
is the complaint with which
the patient presents him/herself to the doctor’s surgery or hospital
emergency department. There can be more than one presenting com-
plaint, in particular with elderly patients. Asking about the presenting
complaint requires a series of questions in a particular order:
e.g a. How do they compare to a migraine?
b. Whereabouts do you get these headaches?
c. How long do they tend to last?
d. How long have you had the headaches?
e. Are there any other symptoms?
f. Can you describe the pain?
g. What seems to improve the situation for you?
h. When do they come on?
Past medical history
(
PMH
) is the information regarding the pa-
tient’s previous health prior to the presenting complaint. This in-
volves: past illness, childhood illnesses (mumps, measles, chicken pox
etc.), immunization, surgical procedures, accidents and injuries, preg-
nancies (for women), allergies (including food, medication, over-the-
counter medication, hay fever treatments, etc.). A complete PMH is