a complete ros?

[Halaljello]

anyone know a way to do a thorough ROS that's quick, efficient and easy to remember? what do most of you folks "say"

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[AF_PedsBoy]

Go general, head to toe, then neuro, and if you know what you're looking for, you will better be able to figure out what questions to ask. Here's a quick example - it'll be short and incomplete since my brain is slowly entering hibernation as graduation draws near! -
* * * * * *
General: Look for cancer, thyroid, sepsis... Any fever/chills, night sweats, weight changes (especially loss, and know how much in, say, a month), heat/cold intolerance, hair/nail changes, episodes of syncope/vertigo/orthostatic hypotension, appetite, sleep disturbance

Head: Blurry/double vision, tinnitis/ear pain, dysphagia, neck stiffness

Lungs: Dyspnea.

Cardiac/Chest: Palpitations, tachycardia, chest DISCOMFORT (which includes pain AND atypical MI/GERD, referred pneumonia, etc.) How many pillows do you sleep with. Leg swelling.

GI: Diarrhea, constipation, blood in stool, abdominal pain, incontinence

GU: Dysuria, frequency, discharge, urgency, incontinence, blood in urine

Muscle/Skin: Joint pain/swelling, muscle pain, rashes

Neuro: Paresthesias, numbness, loss of strength, ataxia
* * * *

 

[Jaded Knight]

Too much effort to actually remember a ROS. Do what I did... type a ROS list in plain english on half a page and give it to the patient to circle whatever they have while you're doing their H&P.

 

[AF_PedsBoy]

Useful as a third year, but by the time you get to be a fourth year you've done it so many times it's second nature. Also a time saver since if anything DOES come up positive you can take the thirty seconds to follow it up and do a more direct line of questioning. Just don't make the mistake I did as a third year and ask each symptom one at a time - after the first agonizing fifteen minute review of symptoms I learned to ask them in groups of three ...enough to speed it up, but not so many that the patient loses track of what you just asked them

 

[double elle]

I find I individualize my ROS questions to the patient. Not by age - but by quickly determining their ability to remember things (elderly, confused) or their ability to understand the questions.

For example, someone who has been in the hospital a LOT will be able to completely describe how frequently they have dysuria, or how many times they have to go to the bathroom in the night. These people will also be able to describe their chest pain in detail.

However, a "simple" person who hasn't had much exposure to health care may not understand anything you are asking. So, I tend to ask things like "have you had any funny or wierd feelings in your chest? - Like your heart beating funny or anything like that?" When I have a patient that may be at risk for vascular disease, I ask about when they go grocery shopping "Can you walk around the grocery store and get your shopping done without having to sit down because your legs hurt - or without having to sit down because you can't catch your breath?"

Also - don't worry about using words like "poop" or "pee" - because some people don't know what you are talking about when you say bowel or urine. Just talk on the patient's level and try not to confuse them...of course, don't underestimate their intelligence...but try to talk to them - not over them. You'll get a feel for this when you introduce yourself and ask why they are here...by asking questions tailored to them, you will not only get the information that is important, you will build a good relationship and they won't think you are a little medical student snot.(haha).

 

[Chisel]

anyone know a way to do a thorough ROS that's quick, efficient and easy to remember? what do most of you folks "say"

Don't try to memorize. When I do it, I look at the head and I think of anything that may be going on related to it. I do this for HEENT, Neck, CV, Chest, Abdomen, etc. Don't forget general - weight loss, energy level, etc.

By doing it anatomically you won't forget anything. Then when you do the write-up, you just do it by system. You can cover everything with this method.

I also tend to try to ask for a few symptoms at a time. Asking one at a time, especially to a talkative patient, can really use up a lot of time.

Chisel
MSIII PCOM

 

[Smurfette]

I do it while doing the physical...makes it quicker overall to do the H&P, plus the physical part I am examining is what "triggers" my ROS questions. I also believe in asking ROS in threes for things not likely to be positive or for the verbose patients (i.e. w/high likelihood of a so-called "positive ROS") who tend to ramble on about things.

You'll do it so many times, and get better at identifying the important questions to ask, don't stress too much now...it will come!