D2FMC3

This is the mnemonic that I teach my house officers to remember questions that they need to ask when they going through the past medical history. It stands for duration, diagnosis, follow-up, medications, compliance, control and complications.

DURATION: It is important to know the durations as the longer that once has the illness the more likely that the person has already developed complications from it. It is better to state the year that the diagnosis was made than a vague number such as 7 years.

DIAGNOSIS: A lot of the times the patient may claim to have a certain condition for an x number of years however we must be aware that they are not healthcare professionals and sometimes even healthcare professionals may have misdiagnosed the patient. In this section the house officer is encouraged to ask for the characteristic of the disease, by whom and where was the patient diagnosed. A diagnosis in a pharmacy is less credible than in UMMC. For example, in the case of bronchial asthma the house officer is encouraged to ask about childhood onset, family history, allergic rhinitis, atopic dermatitis and allergies.

FOLLOW-UP: Unfortunately where you are followed-up does make a difference and knowing this is useful when discharging the patient because we need to know where to send them back to.

MEDICATIONS: Please list the medications the patient is on.

COMPLIANCE: Whether the patient is taking his or her medications regularly? And if not why? Is it due to side effects? Are there any other problems that the patient faces when taking medications?

CONTROL: If you bother to ask you will surprised how well the patient knows his or her sugar level. They may not know what is good control but they do know the levels. For asthma one use the GINA classification.

COMPLICATIONS: This is self-explanatory but some conditions have more of it than others. For example intubation and pneumothorax will be the complications for bronchial asthma. Whereas for diabetes mellitus they include diabetic ketoacidosis, hypoglycaemia, diabetic retinopathy, myopathy, peripheral neuropathy, nephropathy, gastropathy, cataracts and so on.

D2FMC3