History communication skills

History taking > History-taking 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

Reflection	Reflect the heat back to the patient, e.g. ‘Do you have any ideas about what’s causing this?’
Clarification	e.g. ‘What do you feel when you get depressed?’
Normalise	e.g. ‘Some people think about hurting themselves or even about suicide in these situations. Have you ever had thoughts like that?’
Summarise	If 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…

One Comment

Communication skills: – I. Horbachevsky Ternopil National Medical University says:

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7 June 2023 at 14:33

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