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History Taking Skills For Medical Students

History Taking Skills For Medical Students

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History taking skills History taking skills Presentation Transcript

  • HISTORY TAKING SKILLS Dr Syed Raza
  • INTROCDUCTION
    • History taking skills essential in medical curriculum.
    • Objectively being tested in formal exams
    • Forms the base of reaching a correct diagnosis
    • Often ignored/ proper emphases not applied by many
  • OBJECTIVE
    • Key elements in history taking
    • Discuss the standard history taking format
    • Key issues that needs taking care of
    • How you tailor your history as per requirement
    • Workshop (Practical session)
  • Key Elements
    • Introduce your self (name and position)
    • Make a rapport with patient
    • Beginning: ‘ Tell me what brought you to hospital’
    • Middle stem : Follow structured format
    • End: Summarise and ‘Have you got anything else to add or say?’
  • First Impressions
    • Positive Impression
      • Appearance
      • Confidence
      • Demeanor
      • Body Language
  • STANDARD FORMAT
    • Name /age
    • Presenting complaint
    • History of present illness
    • History of past illness (medical or surgical)
    • Drug Medication History
    • History of any allergies
    • Family History
    • Social History (job , support , smoking etc.)
  • Elements of the Comprehensive History
    • Identifying Data
      • Name
      • Age & DOB
      • Sex
      • Race
      • Physician’s Name
  • Elements of the Comprehensive History
    • The Chief Complaint
      • The single most critical concern to the patient
        • “ What seems to be the problem today?”
        • “ What can I help you with today?”
        • Which system (origin) do you believe to be affected by this CC?
        • Do you clearly understand the patient’s complaint or complaints?
  • Elements of the Comprehensive History
    • The Chief Complaints
      • Multiple Complaints
        • “ If I could make one thing better for you, which would you want it to be?”
        • Are the multiple complaints likely to be related?
        • Will you need to address multiple issues?
        • Could some of these be chronic issues?
  • Elements of the Comprehensive History
    • Tips for effective history-taking
      • Open-ended questions
        • “ What seems to be bothering you today?”
      • Closed-ended questions
        • “ Is your chest pain sharp or dull?”
      • Multiple Choice Questions
  • Elements of the Comprehensive History
    • Tips for effective history-taking
      • LISTEN ACTIVELY!!!
        • ACT as if you are listening
        • Repeat patient’s statements
        • Clarify if needed
        • Take notes
        • Display your concern
        • Confront with caution
  • Elements of the Comprehensive History
    • Family History
      • Relative Risk Factors
        • Diabetes, HTN, or Renal Disease
        • Heart Disease, early AMI, early SCD or Stroke
        • Asthma or Allergies
        • Cardiac dysrhythmias
        • Cancer
        • Osteoporosis
        • Mental Illness
  • Elements of the Comprehensive History
    • Systems Review (focused by CC)
      • Generalized symptoms
      • Skin
      • HEENT
      • Respiratory
      • Cardiovascular
        • Central
        • Peripheral
      • Gastrointestinal
    • Systems Review (focused by CC)
      • Urinary
      • Genitalia
      • Musculoskeletal
      • Neurologic
      • Hematologic
      • Endocrine
      • Psychiatric
  • KEY ISSUES
    • ‘ Breaking the ICE’
    • Allowing patient to speak without interrupting unnecessarily. Be a good listener.
    • Taking control where required
    • Open and closed end questions.
    • Make sure you and patient are on the ‘same wavelength’(understanding each other)
    • Treat each patient with respect irrespective of BG
  • Tailoring your history
    • Patient of Myocardial Infarction ( Assess risk factors)
    • Rheumatoid arthritis – Social history
    • Bronchial Asthma/COPD – Social History (job, smoking etc.), allergies and related illness
    • Drug history – must be thorough
  • Special Challenges
    • 1.Sensitive topics – that make patient uncomfortable
    • 2.Silent patient
    • 3.Overly-talkative patient
    • 4.Anxious patient
    • 5.Angry or hostile patient
    • 6.Intoxicated patient
    • 7. Depressed/suicidal patient
  • Special Challenges – contd:
    • 8.Confused patient
    • 9.Patient with language barrier
    • 10.Less intelligent /illeterate patient
    • 11.Patient with learning difficulties
    • 12. Patient with hearing impairment/blindness
  • History taking in Emergency Room
    • Patient usually too sick to give history
    • Patient may be unconscious
    • Little time for history – low priority
    • Cardiac arrest or peri-arrest situation
    • Aim for limited but focussed history from patient or relative.
  • Common Pitfalls
    • Choosing to ask lots of questions to obtain a history WITHOUT also directing initial care or performing a physical exam
    • Patient’s Impression
      • Not doing anything for me
      • Why are we wasting our time here?
      • Stop asking all these silly questions
  • Common Pitfalls
    • Using a tone of voice that sends the wrong message
      • “ What is your ‘Problem’ TODAY Mrs. Jones?
      • “ Why did you call 911?”
    • Patient’s Impression
      • He thinks I call EMS for every little problem
      • I must have called 911 and was not supposed to.
      • I think I am bothering these nice people
  • Common Pitfalls
    • Poor choice of words or using technical terms ( Medical Jargon )
      • How many years has your husband been taking these ACE-inhibitors ?
      • Your wife is experiencing congestive cardiac failure
    • Patient’s Impression
      • What the heck is he talking about?
      • My wife’s heart is failing?!?! Has her heart stopped yet?
      • Son, could you speak English?
  • Workshop (Practical Session)
    • In groups
    • Role play (Simulators ):
    • 1.Doctor 2. Patient 3. Examiner
    • Question –Answer session ( clear your doubts)
    • Feedback
  • Summary
    • Obtaining the history guides the physical exam
    • It is a key / cornerstone for reaching a diagnosis
    • History-taking is accomplished along with the physical exam and further management
    • For emergent patients, the history-taking is limited or never actually obtained in the pre-hospital setting
    • THANK YOU
    • ANY QUESTIONS ??
  •