Patient Interview Questions

Started by Mizoodles
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Mizoodles

Full Member
10+ Year Member
I'm looking for a good list of questions to ask the patient in obtaining the HPI based on their chief complaint. For example, if the patient comes in with a headache it would be a good idea to ask if they have been having vision problems.

Any such list? I can't find any.
 
I made my own lists for about 30 different chief complaints. Now that I'm in Vascular I have made lists for our top 10 consults/cases. I don't think I have used them in months, but as a mental exercise, creating those kinds of lists is just as worthwhile, if not MORE worthwhile than having them.
 
Ehh the objective is not to "just ask a list of questions"....a robot can do that. Your conversation should be focused at least partially on your understanding of the potential pathophysiology. Therefore if someone told me they drank 6 EtOH drinks/day I might ask the CAGE questions and if other biological/social implications of EtOH are present. Or if they had a headache I might ask questions to differentiate between migraine, cluster, tension....where do they occur? how long does it take them to peak? etc...

Then the entire purpose of ROS after the HPI is to make sure you didn't completely miss something not obtained during the HPI.


So to answer your question, if you know your pathology, you will know what questions/answers you need to figure out what is going on. I don't know of anyone who memorizes lists of questions for every possible CC. If you knew your pathology backwards and forwards you could literally generate hundreds of questions for most patients.
 
I'm a week into med school and don't know any pathology, so I need a list to help me generate questions until I can build up the knowledge to actually know what I'm supposed to ask.
 
On most CC, you can always ask about location, severity, pain description, alleviating/aggravating, etc. to get a lot of good info. Experience will help you know the specific questions to ask for "lower GI bleeding", "acute chest pain", etc.

Check out http://en.wikipedia.org/wiki/History_of_the_present_illness#Questions_to_include and pick your favorite mnemonic for memorizing those initial questions.

The one our school teaches is LOCATES.
L = location
O = other symptoms
C = characteristics or quality of symptoms
A = aggravating or alleviating factors
T = timing
E = environmental, emotional, or exertional triggers
S = severity

I also use uptodate and medscape a lot to look up things like "low back pain", "lower GI bleeding" and they have a good overview on important things in your differential.
 
Oh, and as far as generating differentials in your head as you interview to determine follow up questions, VINDICATE has worked pretty well for me. Use it as a checklist. I feel like I can come up with a better one, but am mostly too lazy.

V – Vascular
I – Inflammatory
N – Neoplastic
D – Degenerative / Deficiency
I – Idiopathic, Intoxication
C – Congenital
A – Autoimmune / Allergic
T – Traumatic
E – Endocrine

So someone's in for lower GI bleeding. For vascular I think of angiodysplasia; for inflammatory I think of UC, Chron's, infectious colitis; neoplastic I think colon cancer and blah blah blah.
 
Mizoodles said:
I'm a week into med school and don't know any pathology, so I need a list to help me generate questions until I can build up the knowledge to actually know what I'm supposed to ask.
Click to expand...


Ahh then the purpose of your exercise is to get use to talking to standardized patients, therefore what you ask isn't really important. Just ask whatever you want about their headaches. A good line I use is "So tell me more about that..."

Nobody should expect you to memorize a random list of questions...thats pointless at this point. After second year you will know what to ask.
 
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