Wednesday 19 June 2019

A further elaboration of the art of history-taking

There are two forms of history-taking: that which the disease is known ("please take a history of this patient's diabetes mellitus") and that which the disease is unknown ("this gentleman is short of breath").
If the disease is known we use the D2FMC3 framework outline previously.
If unknown we use the method we most commonly use. My variation of this method will be outlined below:
First we clarify the symptoms and find out what the patient means. Most time the use the words wrongly or imprecisely.
Then we find out the duration.
Then we determine the history of presenting illness. For me there are two components: the character of the symptoms and the differentials.
For the character I use OPPA:
  1. Onset
  2. Progression
    • frequency
    • severity
    • timing
  3. Previous similar symptoms
  4. Aggravating and alleviating factors
Then depending on what the symptoms are I will ask further questions. For example for pain, I will ask the character, site, and radiation.
The illustration is seen here.

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