socrates medicine history taking

It tests both your communication skills as well as your knowledge about what to ask. Repeat back the important points so that the patient can correct you if there are any misunderstandings or errors. if asthmatic, ask if they have ever been admitted to ITU with an exacerbation). Ask if the patient has any medical conditions: If the patient does have a medical condition, you should gather more details to assess how well controlled the disease is and what treatment(s) the patient is receiving. Demonstrating empathy in response to patient cues: both verbal and non-verbal. These are the main systems you should cover: Please note these are the main areas, however some courses will also teach the addition of other systems such as ENT/ophthalmology. Ask the patient if they use recreational drugs and if so determine the type of drugs used and their frequency of use. Ask if the patient has previously undergone any surgery or procedures (e.g. Specific questions vary depending on what type of history you are taking but if you follow the general framework below you should gain good marks in these stations. An appropriate level of eye contact throughout the consultation. The doctor's agenda, incorporating lists of detailed questions, should not dominate the history taking. Time (history) How long the condition has been going on and how it has changed since onset (better, worse, different symptoms), whether it has ever happened before, whether and how it may have changed since onset, and when the pain stopped if it is no longer currently being felt. Introduce yourself, identify your patient and gain consent to speak with them. fluticasone, budesonide, beclometasone), Short-acting antimuscarinic inhalers (e.g. Smoking drugs such as cannabis regularly increases the risk of lung cancer. CB#7110 Chapel Hill, NC 27599 Phone: (919) 966-7776 Fax: (919) 966-2274 This is the time in the history where you can find out if the patient is more at risk of certain diseases. Socrates was an ancient Greek philosopher considered to be the main source of Western thought. This is the opportunity to find out a bit more about the patient’s background. You should also address what the patient thinks is wrong with them and what they are expecting/hoping for from the consultation. Clarify how and when the symptom developed: Ask about the specific characteristics of the symptom: Ask if there are other symptoms which are associated with the primary symptom: Clarify how the symptom has changed over time: Ask if anything makes the symptom worse or better: Assess the severity of the symptom by asking the patient to grade it on a scale of 0-10: If the symptom is shortness of breath, the severity can be bluntly assessed by assessing if the patient is able to speak in full sentences without having to take a breath. During or after taking their history, the patient may have questions that they want to ask you. Continue to periodically summarise as you move through the rest of the history. History taking is a vital component of patient assessment. ipratropium), Long-acting antimuscarinic inhalers (e.g. Have they ever been to clinics? Dispose of PPE appropriately and wash your hands. If a patient complains of pain then there are at least 8 questions that … Also find out who lives with the patient. Open questions are effective at the start of consultations, allowing the patient to tell you what has happened in their own words. You may find that they are the carer for an elderly parent or a child and your duty would be to ensure that they are not neglected should your patient be admitted/remain in hospital. lobectomy, bronchoscopy): Ask if the patient has any allergies and if so, clarify what kind of reaction they had to the substance (e.g. Senior Lecturer Gemma Hurley uses a mock patient to take you through the principles of obtaining a clinical history for www.NurseLedClinics.com. mild rash vs anaphylaxis). It is also important to ask about any complications associated with the condition including hospital admissions (e.g. Record the frequency, type and volume of alcohol consumed on a weekly basis. Surgical history – in examination you need to look for scars on the chest – e.g. o Allergies (N.B. Introduce yourself – name/role Confirm patient details – name/DOB Explain the need to take a history Gain consent Ensure the patient is comfortable Medical conditions relevant to respiratory disease include: Ask if the patient is currently taking any prescribed medications or over-the-counter remedies: If the patient is taking prescribed or over the counter medications, document the medication name, dose, frequency, form and route. coal mining, farming), Neuromuscular conditions (e.g. He was condemned to death for his Socratic method of questioning. Active listening: through body language and your verbal responses to what the patient has said. Allergies; Cardiac drugs A detailed overview of the most commonly used mnemonic SOCRATES for taking a pain history. It is most commonly used to explore pain, but it can be applied to most other symptoms, although some of the elements of SOCRATES may not be relevant to all symptoms. o Check whether patient is regularly taking them. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. Chest Pain – History Free medical revision on chest pain history taking skills for medical student exams, finals, OSCEs and MRCP PACES Introduction (WIIPP) Wash your hands Introduce yourself: give your name and your job (e.g. When you are happy that you have all of the information you require, and the patient has asked any questions that they may have, you must thank them for their time and say that one of the doctors looking after them will be coming to see them soon. You should also ask the patient if they use any illegal substances, for example: cannabis, cocaine, etc. This will help ensure your consultation is more natural, patient-centred and not overly formulaic. See our alcohol history taking guide for more information. A key component of history taking involves exploring a patient’s ideas, concerns and expectations (often referred to as ICE). Open, relaxed, yet professional body language (e.g. Closed questions can allow you to explore the symptoms mentioned by the patient in more detail to gain a better understanding of their presentation. Chandrayee Pattanayak General Medicine. To identify and characterize the pain symptoms, EMTs or doctors can use SOCRATES rule. Hobbies such as bird-keeping can increase a patient’s risk of developing allergic extrinsic alveolitis (often referred to as ‘bird fancier’s lung’). This guide is designed for students and doctors. Some examples of symptoms you could screen for in each system include: If the patient’s symptoms are suggestive of an infective aetiology, particularly tuberculosis (TB), take a travel history to assess exposure risk (e.g. Medical Mnemonic SOCRATES for the diagnosis of pain. uncrossed legs and arms, leaning slightly forward in the chair). His family’s wealth meant he received a good education. Once you have summarised, ask the patient if there’s anything else that you’ve overlooked. Enjoy the videos and music you love, upload original content, and share it all with friends, family, and the world on YouTube. Introduction (WIIPP) Wash your hands; Introduce yourself: give your name and your job (e.g. A collection of surgery revision notes covering key surgical topics. Medical imagery licensed under Creative Commons Attribution-Share Alike; sourced from Wikipedia All other textual content, imagery, and website design, copyright © 2020 Medistudents; all rights reserved. If you'd like to support us and get something great in return, check out our PDF OSCE Checklist Booklet containing over 100 OSCE checklists in PDF format. Drug history. Taking a proper history means listening carefully to what the patient has History taking in Medicine 1. Onset – When did the pain start, and was it sudden or gradual? Symptoms that are typically associated with respiratory disease include: The SOCRATES acronym is a useful tool for exploring each of the patient’s presenting symptoms in more detail. History Taking and Clinical Examination Skills forHealthcare Practitioners module1Debs ThomasFaculty Senior Educatordeborah.thomas@heartofengland.nhs.uk 2. co-amoxiclav, doxycycline, azithromycin), Aspirin (may worsen haemoptysis if already present), St John’s Wort (an enzyme inducer which may reduce the effects of warfarin), Beta-blockers and NSAIDs (bronchoconstriction), Oestrogen-containing medication (increased risk of pulmonary embolism), Amiodarone and methotrexate (pleural effusions, interstitial lung disease), the type of accommodation they currently reside in (e.g. AQA A Level Sociology Book One Including AS Level R. Webb, H. Westergaard. Problematic gambling can be assessed via the, Start typing to see results or hit ESC to close, DNACPR Discussion and Documentation – OSCE Guide, Cervical Spine X-ray Interpretation – OSCE Guide, Musculoskeletal (MSK) X-ray Interpretation – OSCE Guide, medical MCQ quiz platform at https://geekyquiz.com, Loss of Consciousness History Taking – OSCE guide, Emergency Contraception Counselling – OSCE Guide, Progesterone Depot Injection Counselling – OSCE Guide. A useful acronym for this is ICE [I]deas, [C]oncerns and [E]xpectations. salmeterol, formoterol), Inhaled corticosteroid inhalers (e.g. Those working in shipyards, construction and plumbing may have been exposed to asbestos increasing their risk of mesothelioma. Socrates (/ ˈ s ɒ k r ə t iː z /; Ancient Greek: Σωκρᾰ́της Sōkrátēs [sɔːkrátɛːs]; c. 470 – 399 BC) was a Greek philosopher from Athens who is credited as one of the founders of Western philosophy, and as being the first moral philosopher of the Western ethical tradition of thought. Peak Expiratory Flow Rate (PEFR) Technique, Cerebrospinal Fluid Results (CSF) Interpretation. The Hippocratic Oath is an oath of ethics historically taken by physicians.It is one of the most widely known of Greek medical texts. Taking a history from a patient suffering from acute or chronic pain is necessary for correct examination and providing medical care. Psychological history – you can blunt this question by asking if they are under any other consultants / go to any clinics? Some general communication skills which apply to all patient consultations include: Use open questioning to explore the patient’s presenting complaint: Provide the patient with enough time to answer and avoid interrupting them. stairlift, home oxygen), who else the patient lives with and their personal support network, what tasks they are able to carry out independently and what they require assistance with (e.g. See also. Taking a history from a patient is a skill necessary for examinations and afterwards as a practicing doctor, no matter which area you specialise in. Facilitate the patient to expand on their presenting complaint if required: Once the patient has finished speaking, it is helpful to check if there are any other issues. A systemic enquiry may also identify symptoms that the patient has forgotten to mention in the presenting complaint. house, bungalow) and if there are any adaptations to assist them (e.g. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. Intended Learning Outcomes• Outline why a systematic approach to historytaking is required.• Discuss how to prepare for taking a patient history.• He initially studied for nine years and his education had a wide curriculum covering reading, writing, spelling, poetry, singing, music, and physical educa… () ... Popular books for Medicine, Health and Social Sciences. History taking also enables you to build a rapport with the patient through good communication skills. twice daily carer visits), pack-years = [number of years smoked] x [average number of packs smoked per day]. This is what the patient tells you is wrong, for example: chest pain. Respiratory history taking is an important skill that is often assessed in OSCEs. Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. asthma, eczema, hay fever, cystic fibrosis, lung cancer): If one of the patient’s close relatives are deceased, sensitively determine the age at which they died and the cause of death: Explore the patient’s social history to both understand their social context and identify potential respiratory risk factors. Depending on the PC it may also be pertinent to find out whether the patient drives, e.g. Gambling is causative of several decrements to health directly, such as increased sedentary behaviour during the time spent gambling, poor sleep, reduced levels of self-care and anxiety. Ask the patient if they’re currently experiencing any side effects from their medication (e.g. Socrates: It is, I concede, more challenging for those of us wishing to promote public understanding of science-based medicine. The SOCRATES acronym (explained below) is a useful tool that you can use to explore each of the patient’s presenting symptoms. Making sure not to interrupt the patient throughout the consultation. Any specialist can see why Levin wished to put the discussion of medicine in its context, but non-specialists (and probably some students) will struggle to understand why a book on medicine and philosophy starts with the ethical theories of Callicles and Socrates. A detailed overview of the most commonly used mnemonic SOCRATES for taking a pain history. Hippocrates was born around 460 BC on the Aegean Island of Kos. History Taking – Overview. This feature is not available right now. Please try again later. Explore the patient’s current and previous occupations to identify potential exposure to agents which can lead to respiratory disease: Ask if the patient has any pets: allergies to pets are common and may not be immediately obvious (e.g. Explain that you’d like to take a history from the patient. Listening is at the heart of good history taking. travel through areas of high TB prevalence). Ask if the patient regularly exercises (including frequency and exercise type). I'm a British medical student approaching final year after the summer. At this point it is a good idea to find out if the patient has any allergies. This is also a good way to present your history. Problematic gambling can be assessed via the Problem Gambling Severity Index (PGSI). Calculate the number of ‘pack-years‘ the patient has smoked for to determine their cardiorespiratory risk profile: See our smoking cessation guide for more details. Carol Carden Carol_Carden@med.unc.edu Division of General Medicine 5034 Old Clinic Bldg. His family was relatively wealthy – his father, Heracleides, is thought to have been a physician and his mother, Praxitela, was the daughter of a nobleman. The exploration of ideas, concerns and expectations should be fluid throughout the consultation in response to patient cues. If the patient has multiple presenting complaints, work with them to establish a shared agenda for the rest of the consultation: History taking typically involves a combination of open and closed questions. Remember to ask about smoking and alcohol. Gather some information about the patients family history, e.g diabetes or cardiac history. It is most commonly used to explore pain, but it can be applied to most other symptoms, although some of the elements of SOCRATES may not be relevant to all symptoms. Confirm the patient’s name and date of birth. A collection of anatomy notes covering the key anatomy concepts that medical students need to learn. Summarise the key points back to the patient. This allows you to check your understanding of the patient’s history and provides an opportunity for the patient to correct any inaccurate information. Check out our brand new medical MCQ quiz platform at https://geekyquiz.com. Complete your history by reviewing what the patient has told you. dry cough with ACE inhibitor): Medications commonly prescribed to patients with respiratory disease include: Some over the counter drugs which may impact the respiratory system include: Medications with respiratory side effects include: Ask the patient if there is any family history of respiratory disease (e.g. Coal mining is associated with the development of pneumoconiosis. the patient has a wheezy chest when at home, but not when outside). Nurses need sound interviewing skills to identify care priorities. SOCRATES is a mnemonic acronym used by emergency medical services, doctors, nurses and other health professionals to evaluate the nature of pain that a patient is experiencing. Gain as much information you can about the specific complaint. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. Jul 25, 2017 15296 views. History Taking – A Simple Guide Learning to take a good history is crucial to determine a diagnosis and subsequent treatment plan. from lobectomy. It is important you do not forget the general communication skills which are relevant to all patient encounters. This post will cover the basic areas to cover in your history taking. A systemic enquiry involves performing a brief screen for symptoms in other body systems which may or may not be relevant to the primary presenting complaint. Establishing rapport (e.g. asking the patient how they are and offering them a seat). Gather information about a patients other medical problems (if any). leaflets) about what they are asking. Signposting: this involves explaining to the patient what you have discussed so far and what you plan to discuss next. Explore the patient’s general social context including: Record the patient’s smoking history, including the type and amount of tobacco used. Gain consent to proceed with history taking. Find out what medications the patient is taking, including dosage and how often they are taking them, for example: once-a-day, twice-a-day, etc. Patients with respiratory pathology can present with a wide variety of symptoms including but not limited to, cough, chest pain and dyspnoea. salbutamol, terbutaline), Long-acting beta-2-agonist inhalers (e.g. How to Take a Medication History | OSCE Guide | Geeky Medics Find out if there are any genetic conditions within the family, for example: polycystic kidney disease. Dr. Louise Gooch, ward doctor) Identity: confirm you’re speaking to the correct patient (name and date of birth) Should you wish to take notes as you proceed, ask the patients permission to do so. Farmers are at increased risk of developing allergic extrinsic alveolitis. Or the maximal site of the pain. Include also whether if it is progressive or regressive. Gather a short amount of information regarding the other systems in the body that are not covered in your HPC. Introduce yourself, identify your patient and gain consent to speak with them. Signposting can be a useful tool when transitioning between different parts of the patient’s history and it provides the patient with time to prepare for what is coming next. History Taking Template Wash your hands Introduce yourself, and ask permission to take a history General information Name: Age: Sex: Occupation: Presenting Complaint: A short phrase describing the presenting complaint in the patients own words History of Presenting Complaint: Mnemonic - SOCRATES for pain Site - Where is the pain? Closed questions can also be used to identify relevant risk factors and narrow the differential diagnosis. self-hygiene, housework, food shopping), if they have any carer input (e.g. This culture is philosophically justified in being sceptical of statements regarding science which speak in terms of ‘facts’, ‘proofs’ and ‘certainties’. Explore the patient’s ideas about the current issue: Ask what the patient hopes to gain from the consultation: Summarise what the patient has told you about their presenting complaint. past medical history, family history, social history). Wash your hands and don PPE if appropriate. When taking a respiratory history it’s essential that you identify risk factors for respiratory disease as you work through the patient’s history (e.g. A collection of free medical student quizzes to put your medical and surgical knowledge to the test! Deciding on which symptoms to ask about depends on the presenting complaint and your level of experience. As such, unless you are absolutely sure of the answer it is best to say that you will ask your seniors about this or that you will go away and get them more information (e.g. History taking is not a simple, basic skill but a complex one: choosing the right questions and then interpreting the answers to decide what to ask or do next requires skilled clinical reasoning. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. This may be with a child or an adult with impaired mental state. Hey guys, I was just wondering if anyone had any good sites or similar resources for history-taking mnemonics. PAIN HISTORY TAKING POINTS (SOCRATES) Site – Where is the pain? Clinical History Taking 1. following an MI patient cannot drive for one month. history taking really is a "muddle of questions", it reflects poor teaching in clinical method which both authors - as teachers in the Medical School in Brisbane - could have tried to improve instead of dismissing. Explain what you have covered so far: “Ok, so we’ve talked about your symptoms, your concerns and what you’re hoping we achieve today.”, What you plan to cover next: “Next I’d like to quickly screen for any other symptoms and then talk about your past medical history.”. cystic fibrosis, alpha-1 antitrypsin deficiency), Occupational exposure (e.g. The SOCRATES acronym is a useful tool for exploring each of the patient’s presenting symptoms in more detail. : NKDA = No Known Drug Allergies) o Immunisations (especially if a child or other risk factors) Family History: (FHx) Some diseases run through families. Demonstrating these skills will ensure your consultation remains patient-centred and not checklist-like (just because you’re running through a checklist in your head doesn’t mean this has to be obvious to the patient). asthma, COPD), Family history of respiratory disease (e.g. History Taking - The Socrates Pain Assessment Tool Anyone who's ever taken a patient's medical history will know that it involves the skill of asking a lot of specific and personal questions. Should you wish to … Introduce yourself – name / role Confirm patient details – name / DOB Explain the need to take a history Gain consent Ensure the patient is comfortable A good history is one which reveals the patient's ideas, concerns and expectations as well as any accompanying diagnosis. This guide provides a structured approach to taking a respiratory history in an OSCE setting. In practice you may sometimes need to gather a collateral history from a relative, friend or carer. Pre-existing respiratory disease (e.g. The above example involves the CVS so you would focus on the others. Sticking with chest pain as an example you should ask: The SOCRATES acronym can be used for any type of pain history. If you are applying for medical school and would like more information on the UCAT please check out our complete guide and our guide on how to practice for your exam. tiotropium), Antibiotics (e.g. Signposting, in a history taking context, involves explicitly stating what you have discussed so far and what you plan to discuss next. History of the present illness; SAMPLE history Patients with a gambling problem are also more likely to have substance misuse issues.1. It can be challenging to use the ICE structure in a way that sounds natural in your consultation, but we have provided several examples for each of the three areas below. motor neurone disease), Short-acting beta-2-agonist inhalers (e.g. These questions aren’t necessarily there to test your knowledge, just that you won’t try and 'blag it'. You can also ask how far a patient is able to walk (either on the flat or at an incline) without having to stop to take a breath to get an idea of their current performance status. HISTORY TAKING Dr Nooruddin Jaffer Prof of Medicine Hamdard Medical College Karachi(Pakistan) 2. Dr. Louise Gooch, ward doctor) Identity: confirm you’re speaking to the correct patient (name and date of birth) […] Introduce yourself to the patient including your name and role. I've been reading this Reddit with interest for a while and have been successfully employing online spaced repetition for several years. Ask the patient if they have any questions or concerns that have not been addressed. Important respiratory risk factors include: A key component of history taking involves exploring a patient’s ideas, concerns and expectations (often referred to as ICE) to gain insight into how a patient currently perceives their situation, what they are worried about and what they expect from the consultation. Learn how to take a history of pain. Ask the patient if they gamble and if they feel this is a problem. Free medical revision on history taking skills for medical student exams, finals, OSCEs and MRCP PACES. SOCRATES is a pain diagnosis mnemonic that will … It is very important that you don’t give them any false information.

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