questions you always ask to patients

[njslex16]

I'm always forgetful when it comes to asking patients the right questions, and I feel like my H&Ps, soap notes, etc are all lacking because of this. Are there any questions that you ask EVERY SINGLE TIME to each patient that you see? Also, if anyone has a good template for formulating great notes (especially in terms of the assessment and plan), please let me know . Gracias!

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[SeminoleVesicle]

OPQST

Onset, Progression, Quality + Quantity (Pain Scale), Setting, Timing

 

[DocVapor]

I have learned:

OPQRST - Onset, Provocation, Quality, Radiation, Severity, Timing

SMASHFM - Social Hx, Medical Hx, Allergies, Surgical Hx, Hospitilizations, Family Hx, Meds

For Social Hx:
FEDTACOS - Food, Exercise, Drugs, Tobacco, Alcohol, Caffeine, Occupation, Sexual Hx

Those are the basics. There are many more mnemonics depending on PT presentation.

 

[link2swim06]

I'm always forgetful when it comes to asking patients the right questions, and I feel like my H&Ps, soap notes, etc are all lacking because of this. Are there any questions that you ask EVERY SINGLE TIME to each patient that you see? Also, if anyone has a good template for formulating great notes (especially in terms of the assessment and plan), please let me know . Gracias!

The only question I ask every time is 'what brings you in today' or 'how are you doing today.'

Ask questions to include/exclude items on your differential. Every complaint will generate different questions. Know the symptoms/criteria for diseases and try to cover as much as you can remember off the top of your head. The pertinent negatives are as important to include in your note as the positives.

The hands down best 'templates' are actually just reading residents or attendings notes. Every specialty has their own style (i.e. read an ob vs. medicine vs. psych note). After you read 3-4 notes you quickly get the idea of what they want in the notes and don't want in the notes. Day one, I generally print some of their notes and keep them handy to refer to throughout the rotation.

 

[VisionaryTics]

"When was the last time you had a bowel movement?"

 

[michaelrack]

"When was the last time you had a bowel movement?"

You will need to rephrase that a little for patients with a colostomy.

 

[Kaputt]

"When was the last time you had a bowel movement?"

Or, more generally, how is your pooping and peeing?

 

[FutureInternist]

I have learned:

OPQRST - Onset, Provocation, Quality, Radiation, Severity, Timing

SMASHFM - Social Hx, Medical Hx, Allergies, Surgical Hx, Hospitilizations, Family Hx, Meds

For Social Hx:
FEDTACOS - Food, Exercise, Drugs, Tobacco, Alcohol, Caffeine, Occupation, Sexual Hx

Those are the basics. There are many more mnemonics depending on PT presentation.

OLDCARTS
Onset
Location
Duration
Character
Alleviating/Aggravating factors
Radiation
Timing
Sxs (associated with the complaint)

Works best for pain issues but can be used for most things (atleast in IM)

Also 2nd the "What brings you in today".
Chest burning due to a chili eating contest becomes Chest pain in a 50 yr old DMer by the time they get to ER, becomes NSTEMI by the time you get called
If what brought them there is a chronic issue, then ask what changed or did not change that made them come in that particular day - "Did the pain get worse, or was it that it wasn't getting better than brought you in today"

 

[DocVapor]

OLDCARTS
Onset
Location
Duration
Character
Alleviating/Aggravating factors
Radiation
Timing
Sxs (associated with the complaint)

Works best for pain issues but can be used for most things (atleast in IM)

Also 2nd the "What brings you in today".
Chest burning due to a chili eating contest becomes Chest pain in a 50 yr old DMer by the time they get to ER, becomes NSTEMI by the time you get called
If what brought them there is a chronic issue, then ask what changed or did not change that made them come in that particular day - "Did the pain get worse, or was it that it wasn't getting better than brought you in today"

D'Oh. I forgot about the OLDCARTS. The OPQRST is a holdover from my EMS days. I also love the suggestion about the "What brings you in today?" I can't count how many times I've showed up to a patients home at 3 am because they have been nauseated or weak or had back pain for the past week.

 

[VisionaryTics]

You will need to rephrase that a little for patients with a colostomy.

I've attempted rectals on patients with patients with permanent colostomies. Asking dumb questions is no sweat.

 

[Planes2Doc]

Definitely OLD CARTS.

Everything that comes after HPI kind of throws me off still.

 

[NeuroLAX]

D'Oh. I forgot about the OLDCARTS. The OPQRST is a holdover from my EMS days.

I had never heard of OLDCARTS until med school. I always remember it as OPQRST from my EMS First Responder course. 😀

 

[mimelim]

You guys ask every patient OLDCARTS or any of those things? The only question every person gets asked every day is "How are you feeling?" Everything else is based on what they are in the hospital for.

 

[LossForWords]

I always ask about DNR/DNI as well.

"Well sir/madam, I ask this question of everyone who comes into the hospital whether they've stubbed a toe or are having a heart attack. In the event that your heart or breathing were to stop, would you want us to attempt to resuscitate through measures like chest compressions, intubation, or defibrillation?"

 

[cowme]

as a radiologist, I don't need to ask anything. We are already aware that every patient suffers from "diffuse pain, r/o pathology"

 

[SLC]

"So what brings you in to see us today?"

But I'm an M2 so I haven't spent time on an inpatient unit yet.

 

[pinipig523]

I'm an ER attending.

My go-to line has become, "Of all days, why today?"

 

[inspirationmd]

Get in the habit of asking key ROS questions so you can have a 10 pt ROS for your H&P. Not hard: fevers, chills, neck pain, blurry vision, CP, SOB, etc. Of course add the pertinent ones but it also makes it easy to organize presentations in your head so you are not handicapped by paper when you present to residents and attendings. Take notes for yourselves but if you can present off the top of your head it makes it easier to earn that "level of resident" designation for your presentations. Also makes things a bit easier when you start as an intern.

 

[GoSpursGo]

I'm an ER attending.

My go-to line has become, "Of all days, why today?"

I actually like this one and use it quite a bit when I'm getting an H&P even if I'm not in the EC. Either this question, or "What was the tipping point that made you decide to come to the hospital," or some derivative of that can give you insight into what changed to prompt them to come in.

Other than that, I agree that really the only question that everyone gets is "why are you here." That said, when you're first starting out it's hard to get a feel for what is and isn't relevant for a given patient, so these acronyms and coming up with your own 10 point ROS that you use on everyone isn't a horrible place to start (though please only mention the truly pertinent positives and negatives in your presentation, ie you don't need to give a detailed sexual history on someone who came in with a cough). Everyone has some growing pains as they find out what needs to be on your differential when someone comes in with a specific chief complaint and which questions are needed to rule in/out certain diagnoses.

 

[mjl1717]

In an unstressed voice: Do you have anymore questions for me?

 

[krps85]

I'm an ER attending.

My go-to line has become, "Of all days, why today?"

i like this one! gotta keep it mind when I do my ED month, last hurdle before graduation 😎

 

[EnergyDrink]

I'm an ER attending.

My go-to line has become, "Of all days, why today?"

I love this!