need help w/my history skills

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me454555

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I'm an MS 2, are there any books you can recommend that would help me take a better focused history. I always seem to forget/don't ask some of the pertinant questions related to a system. Any books out there that you can recommend?
 
u just need practice. u are going to forget something the attending will ask you and you will remember next time.
 
Bates Guide to the History and Physical (It's this big green leather-bound book)

And another green book called "the clinical encounter"
 
You might see if you can bum a little plastic card from a drug rep that has an abbreviated H&P guide plus tips on ROS.

I have one, and I always find it helpful to keep in my pocket in case I think I'm forgetting something.

If you can find one, I think you'd be glad to have it during those times when you're drawing a blank.

medpa
 
It's a matter of practice. The plastic pocket cards aren't bad to help, but you mostly need to practice. Besides, every attending and department will be different in what they consider important questions to ask during the history. Some want to know if a pt has hot/cold intolerance, others realize the absurdity of asking this of every patient.

Also, after you get the HPI make a differential in your head. Then ask questions, systems based, that would help you eliminate/confirm things from your differential.
 
Maxwell's has a great ROS in case you have trouble remembering everything.
 
I actually think that reading articles about the clinical manifestation of diseases or texts like CMDT helps a great deal in learning about signs/symptoms and differentials. Books about H&P's or cards with ROS on them may help, but they don't really help you understand disease. With that being said, it is quite obvious that experience is the true teacher.

The more you understand about the etiology of disease states, as well as what things commonly manifest in similar fashions, the better you will become at learning what questions to ask. Generally, the best way to approach and HPI is to ask questions to describe in detail the nature and duration of the chief complaint (how long, where, what makes it better/worse, intensity, etc). Then, as the patient provides you with information, you should start to get a differential in your mind, which allows you to ask questions that rule in or rule out certain illnesses. As things get narrowed down in your mind, you can begin to ask about risk factors, common comorbidities, etc. I've had some attendings who use this general approach and recommended it as a good thorough approach to eliciting a solid HPI. Other people may have devised different methods, but this one seems to work really well for me.

By the end of your HPI, the audience should have an idea in their head as to what is going on (or atleast be thinking about how to further narrow down the differential), then by the end of the exam/labs/imaging your assessment should be confidently stated and supported by your subjective and objective findings. It is all about building and case that makes sense.

Hope this helps.
 
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