taking good histories

[seanth]

---

Members don't see this ad.

I was wondering if anyone has any particularly good suggested reading for getting better at history taking. I'm an M3 and while I can usually get the important stuff out of the patient, but I'd really like to do it more efficiently while also making the patient comfortable. (I didn't do so well on a recent OSCE, but obviously this is a skill that's really important anyway)

 

[TMP-SMX]

Practice. You'll make connections to which questions are key for the chief complaint and keep things open ended so they do the work for you. Knowing the right ROS questions is also a skill to stay efficient. Making the patient comfortable can be done in multiple ways. Have good eye contact, smile once in a while when appropriate, acknowledge what they are feeling, and importantly be confident.

I don't think there is anything you can read to teach you how to do a good interview as it is something you have to practice to get better at. Obviously Bates will improve your skills but practice is how you remember everything.

 

[mglavin]

This is one of those "art of medicine' areas, taking the convoluted story a patient tells you and turning it in to a coherent presentation and problem list in your mind. One thing that i have recently started doing which has helped my organization is filling in a problem list on the paper im recording the CC, HPI PHx ROS PE finding on right away. So far it has helped me stay organized. The HPI is usually the last thing i flesh out becasue the patient is normally all over the place when you ask them the open ended questions. As for OCSE the OPQRST thing works very well becasue the fake patient is problably trained well to know the anwsers to these questions while a real patient won't or will be very inconsistant.

 

[Acherona]

when you are taking a history, ask yourself the question "what question can i ask whose answer will most affect the diagnosis, treatment or management?" These are usually the most important questions to get out of the way at the beginning of the history and what your team will be most interested in. The problem is it's hard to know what those questions are as a third year, it just takes practice. The other thing is, there are about three types of patients - there are the ones who can answer open-ended questions, will give you a nice coherent story/timeline that you can just flesh out afterwards with pointed questions, there are the ones who for whatever reason can only answer yes/no or very specific questions, and then there are the comatose/demented/delirious ones that will give no history. Identify which group the pt falls under very early and don't waste your time listening to the rambling. If you do end up listening to the rambling, do not include it in the HPI. A rough organization for HPI that I have in my head is: 1. patient presents with (cheif complaint) 2. context of chief complaint (where, when, how long etc) 3. other associated symptoms and relevant positives 4. relevant negatives 5. other important background 6. ROS 7. ED course

 

[Substance]

Read. The more knowledge you have about the science of medicine, the more able you will be to direct the interview in an efficient manner.

 

[Electrophile]

Reflexive listening is helpful just to make sure they didn't short circuit between their brain and tongue. "So I understand you to say that you have had signs/symptoms for the last three days, is that correct?" Kind of lessens the inevitable moment where they tell you one thing and 10 minutes later, tell the resident/attending something almost completely different. Doctors tend to be just the facts, ma'am while the patient (or client in our case) wants to tell a story. Stick with open ended questions as much as possible, you don't want to lead them down a path. Who/what/when/where/why/how questions are helpful more than yes/no.

 

[braluk]

Be organized so that you can dissect out a patient's history. Additionally, cater your questions to the specialty's characteristics (that is a surgery note should be pretty short, right to the point, while a medicine note will require you run the whole gamut). But mainly, be organized- start with the CC, and organize your questions from there- Onset, frequency, characteristics, etc..etc. Follow CC 1 with CC 2. Follow this with the FHx, SHx, etc..etc.. Everyone will have their own method that works for em. It would also be helpful to run a differential in your head before the patient even talks based upon presentation and change accordingly throughout the interview, which should also help you guide your clinical diagnostic questioning.

 

[thefafo]

I've used this website a lot before OSCE exams, and right before I took Step 2 CS. In the beginning of 3rd year, I used the history section a lot, but that part does get easier with practice and you won't need to use it as often later in 3rd year. The physical exam sections are also useful.

http://meded.ucsd.edu/clinicalmed/history.htm