Wednesday 19 June 2019

Taking a past medical history or history disease known.

If the examiner request that you take a history of a patient's diabetes mellitus , one cannot use the normal methods. Instead I use the D2FMC3 framework.
You must know the:
  1. Duration
  2. Diagnosis
    • presenting symptoms
    • trigger or risk factors
    • gold standard tests done
    • clinical criteria used for diagnosis
    • who and where was the diagnosis
  3. Follow-up
    • regular or irregular
    • defaulted
    • doctor-shopping
  4. Management
    • Non-pharmacological
    • Pharmacological
  5. Compliance
    • If not, why?
  6. Control
  7. Complications
    • disease-related
    • treatment-related
For example: This 50 year old gentleman has diabetes mellitus which was diagnosed in 2015. He first presented with polyuria, polydipsia, and recurrent fungal infection of the genital area. His parents had diabetes mellitus. Both diagnosed in their 50's. Fasting blood glucose was 14.3 mmol/L and HbA1c done by his general practitioner was 9.2%. He is currently being regularly followed-up by his personal GP. He already has been screened for retinopathy, nephropathy, and polyneuropathy. He is under regular ophthalmology follow-up, has seen the foot care nurse and seen the diabetic nurse educator. He is now on metformin 1g bd and basal bolus insulin. He is compliant to his medication though sometimes not compliant to diet restriction. His latest HbA1c is 7.0% and home self-monitoring of blood glucose is between 5.0 to 8.0. He has microalbuminuria and has undergone one previous laser treatment for his left eye and cataracts removed from both eyes. He admits to hypoglycaemic episodes up to once a week usually around 3am and this has affected the compliance to his insulin somewhat.

So hopefully with this framework one can get as much relevant history as is needed.

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