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1. Chest pain
SOCRATES
The SOCRATES acronym is a useful tool for exploring each of the patient’s
presenting symptoms in more detail. It is most commonly used to explore pain, but it
can be applied to other symptoms, although some of the elements of SOCRATES
may not be relevant to all symptoms.
Site
Ask about the location of the pain:
 “Where is the pain?”
 “Can you point to where you experience the pain?”
Onset
Clarify how and when the pain developed:
 “Did the pain come on suddenly or gradually?”
 “When did the pain first start?”
 “Did the pain come on at rest or whilst you were exerting yourself?”
 “How long did the pain last for?”
Character
Ask about the specific characteristics of the pain:
 “How would you describe the pain?”
 “Is the pain constant or does it come and go?”
Radiation
Ask if the pain moves anywhere else:
 “Does the pain spread elsewhere?”
Associated symptoms
Ask if there are other symptoms which are associated with the pain:
 “Are there any other symptoms that seem associated with the pain?”

2. Time course
Clarify how the pain has changed over time:
 “How has the pain changed over time?”
This question can be useful to determine if the chest pain has become progressively
worse over time. An example might be a patient describing chest pain that was
initially only present during exertion which is now also present at rest (e.g. unstable
angina).
Exacerbating or relieving factors
Ask if anything makes the pain worse or better:
 “Does anything make the pain worse?”
 “Does anything make the pain better?”
Severity
Assess the severity of the pain by asking the patient to grade it on a scale of 0-10:
 “On a scale of 0-10, how severe is the pain, if 0 is no pain and 10 is the worst pain
you’ve ever experienced?”
This allows you to assess the patient’s response to treatments (e.g. pain was initially
8/10 and improved to 3/10 with GTN spray).
 Risk factors
 Past History: similar attacks
 Past Medical History
 Drugs history
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SOB
Site: ask where the symptom is (if relevant)
Onset: clarify when the symptom first started and if it the onset was sudden or
gradual
Character: ask the patient to describe how the symptom feels
Radiation: ask if the symptom moves anywhere else

3. Associated symptoms: ask if there are any other associated symptoms
Time course: ask how the symptom has changed over time
Exacerbating or relieving factors: ask if anything makes the symptom worse or better
Severity: ask how severe the symptom is on a scale of 0-10
 Past medical History
 Family history
 Drug history