MD How to make sure you hit all the questions in patient interview?

[SandP]

Hey guys. M2 here.

It seems that whenever I interview a patient, I miss a question. There's always something I didn't think of (forgetting to ask if a woman has regular cycles, for example, when she comes with a complaint in another system or forgetting/not knowing to ask something else specific to the condition). How do you guys ensure a complete, thorough interview (with real, not osce, patients) when your knowledge base is limited? I find this particularly difficult in real life, when patients are apt to wander in their train of thought. Any suggestions?

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[AlbinoHawk DO]

I wouldn't worry about it at this stage in your training. You haven't taken all the classes, haven't taken boards, and you haven't had the experience of knowing what is most commonly seen and not. Over your training you will see what points the attendings/residents most commonly address and eventually you start to build this part of you where you start to think something "doesn't fit" and you keep asking until things start to click.

 

[ACSurgeon]

Hey guys. M2 here.

It seems that whenever I interview a patient, I miss a question. There's always something I didn't think of (forgetting to ask if a woman has regular cycles, for example, when she comes with a complaint in another system or forgetting/not knowing to ask something else specific to the condition). How do you guys ensure a complete, thorough interview (with real, not osce, patients) when your knowledge base is limited? I find this particularly difficult in real life, when patients are apt to wander in their train of thought. Any suggestions?

Until you have extensive clinical experience, you will either miss some things OR do a very thorough ROS, which is not practical in real clinical situations.

A good starting point would be to develop a basic ROS that you become efficient asking. This will ensure you hot most organ systems and potentially help discover new information.

In real life, you'll ask the questions that pertain to the differential diagnosis. In outpatient settings, they have patients answer a long list of ROS questions.

 

[Redpancreas]

Hey guys. M2 here.

It seems that whenever I interview a patient, I miss a question. There's always something I didn't think of (forgetting to ask if a woman has regular cycles, for example, when she comes with a complaint in another system or forgetting/not knowing to ask something else specific to the condition). How do you guys ensure a complete, thorough interview (with real, not osce, patients) when your knowledge base is limited? I find this particularly difficult in real life, when patients are apt to wander in their train of thought. Any suggestions?

Stage 1: Terrified of missing something.
Stage 2: Use a Template
Stage 3: Realize that makes you too formulaic and awkward with the patient.
Stage 4: Create a Mnemonic.
Stage 5: Realize it's got flaws and re-arrange the Mnemonic.
Stage 6: Cycle between stage 4/5 for a while fearing your history skills are plateauing.
Stage 7: Realize that when you see a patient, you should be in the moment instead of thinking of a mnemonic and that awareness will guide you to ask the appropriate question naturally.
Stage 8: Rock it until someone above you asks you about an insignificant detail that you didn't ask which embarrasses you.
Stage 9: Continue with what you were doing in stage 7, but then remembering to run through your Mnemonic as you're preparing to leave the room.
Stage 10: When someone junior to you asks this question, tell them that it comes with experience while hoarding your Mnemonic all to yourself.

 

[jm192]

LOL.

Go back.

 

[togaedere]

This is the best response. Currently starting second year of residency - pretty good at taking a relevant history without extra confounding info, still miss things that I think later are relevant or someone else wants the answer to. The answer to the question is "oh I forgot to ask that! I'll go back and get that info," without sweating it.

You'll be fine.

LOL.

Go back.

 

[anbuitachi]

I'm a resident. still miss stuff all the time. dont worry about it. the patient isn't leaving, if it matters, go back and ask.

 

[operaman]

Ditto. I'm a pretty smart dude and i miss stuff all the time. Just admit you forgot to ask and then go back in and ask. Live and learn.

Pretty sure you'll never ever reach a point where you do this 100% of the time. I see patients all the time referred from experienced attendings who I or my attending ask a question that completely upends their treatment. This is the very crux of the art of medicine.

 

[sliceofbread136]

I carry around a basic ros and of all non hpi stuff to ask. The actual hpi I ask the details surrounding the actual situation and info that I know will effect the differential and management

 

[Lexicon0]

Agree with all of the above. Also, attendings/residents would much rather have a med student that is quick, efficient and misses some pertinent details vs someone who is overly thorough and takes a lot of unnecessary time in patient rooms disrupting the flow of clinic