The Medical Interview

PMH: Immunizations

"Are you up to date on your immunizations?" - Tetanus - Influenza - Pneumococcal - Hep A & B - Zoster - HPV (ask about dates given)

PMH: Childhood Illness

"Did you have any serious health issues/illnesses as a child?"

SH: Spirituality

"Do you have a faith or religion you adhere to?" "How does that impact your health/well-being?"

PMH: Serious Illnesses

"Do you have any other active medical problems?" "Any serious illnesses in the past?" (What / how long ago / outcomes)

HPI: Aggravating Factors

"Does anything make the problem worse?"

PMH: Hospitalization

"Have you ever been hospitalized?" - When? - Where? - Why? - Attending physician? - Outcomes?

PHM: Surgical Procedures

"Have you had any surgeries?" - When? - Where? - Why? - Attending surgeon? - Outcomes?

HPI: Similar

"Have you had anything like this before?"

HPI: Associated Symptoms

"Have you noticed anything else?" "Are there any other symptoms that started around the same time"

HPI: Alleviating Factors

"What has made it better?" Degree of success

PMH: Trauma/Injuries

"What serious accidents or injuries have you had?" - When? - What happened? - Outcome?

SH: Occupation & Education

- "Are you currently employed?" if yes, "What is your job?" - Stress level @ work (1-10) - "Tell me a little about your education." - "Where did you go to high school/college?"

SH: Lifestyle Questions

- "Tell me what you eat in a typical day" - "What do you do for exercise?" - "How do you like to spend your free time?" - "Have you ever used tobacco products?"

SH: Demographics, upbringing, ethnicity

- "Where were you born/grown up?" - "What was your upbringing like?" - "Is there anything impt I should know about your ethnicity?" - "How does your culture affect your health/well-being?"

SH: Relationships & Support Systems

- "Who lives with you right now?" - "Do you have any concerns about your relationships (both romantic and friendship)?" - "Who do you have in your support system?"

PMH: Health Screening

- BP, cholesterol, blood sugar - age > 50 = colonoscopy (40 w/ FH) - males > 50 = prostate cancer screening (40 w/ FH) - females = pelvic exam/PAP smear - females > 40 = mammogram

Introduction

- WASH YOUR HANDS!! - introduce yourself as student - make sure patient is comfy - sit @ patient level - maintain good eye contact - explain what you'll be doing

FH: Familial Patterns

- heart disease - diabetes - cancer - anxiety - depression - high blood pressure - stroke - heart attacks - genetic disorders

PMH: Prescription Medications

- name - purpose (why are you taking it?) - dosage - frequency

Past Medical History (PMH)

- serious illnesses - medications - herbal product/over-the-counter meds - allergies - hospitalizations - trauma/injuries - surgeries - reproductive Hx - childhood illnesses - immunizations - health screenings - personal safety practices

PMH: Personal Safety

- use of sunscreen - seat belt usage - bicycle/motorcycle helmet - firearm storage

3 Objectives of the Medical Interview

1) Gathering info 2) Establishing rapport 3) Educating/supporting the patient

When should you summarize?

1. After HPI 2. At the very end

The Medical Interview

1. Introduction 2. Chief Complaint 3. History of Present Illness 4. Past Medical History 5. Family History 6. Social History / Patient Profile [ROS = review of systems]

Elicit the patient's perspective

1. ideas/beliefs abut the problem 2. fears/concerns/feelings about it 3. impact in daily life 4. expectations about the appointment

History of Present Illness (HPI)

CC and other current symptoms starting from the last time the patient felt well to present

LOCAAATESS

L = location O = onset C = character A = associated symptoms A = aggravating A = alleviating factors T = timing E = environment S = severity S = similar problems in the past

PMH: Reproductive History (female)

Menstruation - age of first menses - date of last period (length of cycle) Pregnancies - # of times - When? - Live births - Miscarriages

PMH: Non-prescription Medications

OTC Meds/Herbal products - name - purpose (why are you taking it?) - dosage - frequency Alternative cares (i.e. acupuncture, ayurveda)

FH: Family members

Parents/sibling/children/grandparents - Date of birth - Alive or deceased (cause) - Health conditions - # of siblings/children

HPI: Onset

When did it start? Acute or gradual?

HPI: Location

Where is the discomfort? (have the patient point exactly where) Does it radiate/travel?

HPI: Environment

context of symptom development

HPI: Timing

duration, frequency, chronology

Family History (FH)

explore the presence/absence of disease in the family

PMH: Allergies

identify allergy and specific reaction (true allergy, general side effect, intolerance)

HPI: Character

quality description of the quality of the symptom (sharp, dull, throbbing, crampy, achey)

HPI: Severity

quantity/amount of pain Scale: 1 - 10

Chief Complaint (CC)

the reason the patient states they are seeking care - use open-ended questions - stated in the patient's words - includes duration of complaint - "What can I do for you today?"

Social History (SH)

understand the whole person (aka: personal profile)