This in the patients own words whats brought them in.
For example you often see something like “pneumonia” in medical notes but the patient would actually come in with something like breathlessness or cough.
History of Presenting Complaint (HPC)
Every individual symptom needs to be explored. This will include:
When it first began
Did the come on suddenly (acutely) or gradually (insidiously)
Duration of symptom
Progression of symptom
Is the symptom there all the time or intermittently
A common approach is to use SOCRATES or some variation of it:
Exacerbating / relieving factors
This is to see if there are any other associated symptoms that are related to what the patient has come in with. In your OSCEs this will help to exclude some differentials and are a large part of getting those precious marks.
Here is a brief overview of what you can ask – if a symptom is present, you’d need to ask the above questions.
There are more system reviews but these are the main ones you’ll need to get started.
Past Medical History (PMH)
We all have a different way of asking this. Some people say things like “have you been diagnosed with anything in the past”, “have you have had treatment for any conditions” or “do you see your GP regularly about any conditions”
For each condition you should write down: date or time of treatment for example: Appendectomy 2011
You should specifically ask about related conditions. These will definitely feature in your mark scheme, most actors are trained to withhold information until promoted.
For example: if you suspect a myocardial infarction (heart attack) it would be a good idea to ask about hypertension (high blood pressure), diabetes (type 1 or 2), high cholesterol etc.
Drug History (DH)
Ask about regular medications. You will need to ask for the dose and frequency
e.g Paracetamol 1G four times a day
Ask if the patient has any allergies – both medication and food. Ask what happens when they take that
Patient: “I am allergic to amoxicillin” Doctor: “What happens when you take that?” Patient: “I come out in a rash all over my body”
Social History (SH)
Smoking – how many a day, for how long?
Alcohol – get the patient to say how much they have in a typical week (then you can work out the units)
Occupation – current or retired. This is more important to some histories such as respiratory (for example exposure to asbestos)
Living arrangement – “who is about home with you”, sometimes it is important to ask about carers, how they do the shopping ect
Family History (FH)
People usually say something like “are there any conditions that run in your family that you are aware of”
In your OSCEs the actors are usually told to be vague, so it is important to ask direct conditions. For example: “has anyone in your family previously had a heart attack”
Ideas, Concerns, Expectations, Feelings
This usually carries some marks in your OSCEs and is a good way to uncover any hidden agendas or points missed in your OSCEs. It is a great way to show the patient (and the examiner) your empathy skills. As a general rule if the actor mentions something twice, it’s probably because they are trying to give you a hint so you can get more marks. This is particularly common in this area of the history.
PC Generalised swelling of abdomen and legs
HPC Seen oncologist this morning, advised to attend A&E for assessment Attended A&E due to swelling in legs and abdomen, worse over past 3 months Previously seen a cardiologist 4 years ago. Exercise tolerance a couple of steps, worse over the past 3 months No: chest pain, palpitations, weight loss