When interviewing patients, establishing trust is essential. Taking a thorough medical history allows clinicians to accurately assess risks and determine if treatment modifications are needed. The initial exam includes checking vitals, conducting a physical exam of major organ systems and the skin, and testing eye acuity to inform the diagnosis and treatment plan.

1. IMEC- Medizin ©

2. When interviewing the patient, it is essential in establishing a relationship of trust between the patient and caregiver. Talking with the patient and obtaining their health histories is usually the first and often the most important part of the health care process

3. This enables a clinician to accurately assess the potential risks presented by a patient, prior to the start of treatment

4. When taking a Medical History A clinician should ask: 1. “Are you having pain or discomfort at this time?” 2. “Do you feel nervous about having to see a physician ?” 3. “Have you ever had a bad experience in reference to your healthcare?”

5. Recent physical or psychological concerns Family History Medications (recent changes) Allergies Weight gain or loss Sleep pattern disturbances Sexual appetite/companionship Exercise Tobacco and Alcohol Use

6. Medical history Dialogue history Physical examination

7. It is important to get a clear understanding of medications, past and present and what the patient and previous physician were attempting to achieve. Again, have there been recent medication changes?

9. High blood pressure Diabetes Heart disease or attack Angina pectoris Heart failure

10. Tuberculosis Asthma COPD/Emphysema Hay fever Sinus trouble Thyroid disease Chemotherapy or Radiation therapy due to malignancy

11. Renal disease Stroke Ulcers Seizure disorder Liver disease Sickle Cell disease Pregnancy

12. History- Does the patient have any previous episodes of anxiety or mental illness Observation: Shaking Itching Sweating Dilated pupils Cold and sweaty palms Nervous appearance "White Knuckle" Syndrome Trembling

13. During the initial exam, certain things must be done!!

14. To determine whether a treatment modification is required, and whether to seek other medical consultation, if indicated. THEN IN CONSIDERING THE PATIENT: To determine patient's ability to physically tolerate any treatment, and To determine patient's ability to psychologically tolerate any treatment.

15. Blood pressure – BP (both arms) Heart rate / rhythm – along with abnormal Heart sound Respiratory rate – Rales/rhonchi/crackles Check O2 Saturation and/or dyspnea on exertion, at all if possible

16. Radial - Medial wrist Brachial - Antecubital fossa Carotid - Groove between trachea & sternocleidomastoid muscle Femoral - Femoral triangle Pedal - Top of the foot (dorsal pedis)

17. Determine if pulse beats are evenly spaced, if so, record as regular, If pulse beats are uneven, record as irregular You can get a better idea if an EKG is available

18. Monitor respiratory rate Observe movement of chest wall. Is it symetrical. Is there cough Is it a productive cough

19. Initial examination of the skin may reveal a lot of pertinent information. Sores, moles, (bacterial) impetigo, various fungal (tinea), and inflammatory (erythema) & histimine reactions (uticaria) ,etc. the dermatologic list goes on and on. Even looking at the skins physical age can tell a lot, via amount of wrinkles and pigments (vitiligo) and in learning if the patient has spider veins

20. Rotation of the head is very important, as well as upward/downward movements Look at the eye sockets and the midline symmetry of the nose. Have them give a chewing motion to check the buccinator and masseter muscles. But remember we are doing more than just checking the cranial nerves!!! Ask if the patient has had headaches, and/or head injuries in the past ? What type?

21. The first part of the eye exam is an assessment of acuity. This can be done with either a standard Snellen Hanging Wall Chart read with the patient standing at a distance of 20 feet or a specially designed pocket card (held at 14 inches) . Each eye is tested independently