Impacts, Concerns and Expectations during History Taking

[MedStudent219]

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Hi all, hope everyone is well.

I’ve been practicing taking my histories and I’ve improved a lot. One thing I still struggle with however is asking about impacts, concerns and expectations during a history. Our med school makes a big deal about it but ihave no clue how to ask any of these in a way thats not just saying “whats concerning you about having —-“ or “what are your expectations of today?” - expectations would be quite obvious wouldnt they during the PC?. I also have no clue where in the history they should be asked. Any information would be really appreciated. Thanks so much all! 😀

 

[libertyyne]

Hi all, hope everyone is well.

I’ve been practicing taking my histories and I’ve improved a lot. One thing I still struggle with however is asking about impacts, concerns and expectations during a history. Our med school makes a big deal about it but ihave no clue how to ask any of these in a way thats not just saying “whats concerning you about having —-“ or “what are your expectations of today?” - expectations would be quite obvious wouldnt they during the PC?. I also have no clue where in the history they should be asked. Any information would be really appreciated. Thanks so much all! 😀

never even heard about impacts concerns and expectations being important during a history. If this is a school requirement literally just ask them if they have any concerns , or any impacts on them and what their expectations are for the visit. When you get to clinicals histories are much more focused and fluid.

 

[mistafab]

It sounds like your school is trying to teach you how to do a "patient-centered" interview.

Thought it is a good skill to learn, it would be prudent to master the basic HPI first and then add in the patient centered aspects. Your school seems to be doing a poor job of integrating it into your history taking. Essentially it boils down to getting what the patient wants/needs/is most pressing, acknowledging that, then moving forward from there with your doctor-centric questioning to fill in the blanks. Once you do more actual practice it should flow better. For now, just do what your school says and try your best.

Good luck!

 

[Osteosaur]

"How has this impacted your routine?" sounds a bit more natural. It covers being able to work, and daily activities of living, without making an unemployed person feel awkward or defensive.

 

[differentiating]

It sounds like your school may be encouraging agenda-setting (“what do you want to discuss today?”/“Ok, let’s focus on X,Y, and Z”) as well as eliciting patient concerns and fears (“what are you worried about/what are you concerned this could be”). Both are really helpful tools for interviewing patients.

 

[Angus Avagadro]

I believe they are emphasizing how the CC is impacting their activities of daily living and the emotional Impact on their lives. This is where you want to a add humanistic and concerned comments.

 

[MedStudent219]

Thank you all for the tips! They were highly valuable 😀