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History communication skills

Start – WIPE  

  • Wash hands
  • Introduce self (full name, grade/role)
  • Patient’s name, DOB and what they like to be called
  • Explain why you are there

  • Briefly mention confidentiality
  • Start with an open question (e.g. ‘OK Tim, what brought you in today?’)
  • During the first 60 seconds (‘the golden minute’), do not interrupt, just facilitate disclosure (e.g. by head nodding, saying ‘yes’, ‘uhum’ etc.)

During

  • Start with open questions and then move to closed questions
  • Try to build a rapport with the patient (e.g. postpartum patient – ‘How was the birth?’)
  • Use signposting: refer back to what you’ve just covered and link it to what you want to move on to (e.g. ‘So you’ve told me about your recent cough. Next I’d like to ask about other medical problems you’ve had in the past.’)
  • Show empathy
  • Respond to cues. It is really important to engage with what the patient says instead of just planning your next question.
    • Cues may be verbal or body language
    • Comment on it, e.g. ‘You look worried.’
    • After you hear a cue, repeat it back to the patient and then ask more about it (e.g. ‘You mentioned that sometimes you feel down. Can you tell me more about that?’)

End

  • Summarise what you have talked aboutto the patient
  • Ask if they have any questions for you
  • Explain the next steps

Integrate ideas, concerns and expectations

  • ICE should be integrated throughout the history
    • Ask about ideas and concerns (e.g. ‘What do you think is going on?’ ‘It has been going on for a while now. Is it worrying you?’)
    • Ask about expectations from consultation (e.g. ‘Was there anything else you wanted to address today?’)

Other tips

  • Things to AVOID
    • Leading questions (e.g. ‘You haven’t missed any doses of the medication, have you?’)
    • Asking multiple questions in one go
    • Giving too much information at once
  • Other techniques
ReflectionReflect the heat back to the patient, e.g. ‘Do you have any ideas about what’s causing this?’
Clarificatione.g. ‘What do you feel when you get depressed?’
Normalisee.g. ‘Some people think about hurting themselves or even about suicide in these situations. Have you ever had thoughts like that?’
SummariseIf your mind goes blank, summarise the recent part of the history
  • Don’t be afraid of pauses, but don’t fill them with ‘ummmmm’ or ‘errrrrrrr’

Try some stations…

  1. Low energy
  2. Child vomiting
  3. Breathlessness
  4. Change in bowel habit
  5. Lots more here!
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