Hi STEMinists! If you are interested in medical studies, this post outlines the questions that doctors are trained to ask at every appointment in their bedside manner classes! Thanks for reading!
1. Chief Complaint (CC) Important questions: What has brought you in today? What is going on? Where and what is causing pain? Goal: To listen to the patient’s concerns and begin to identify what is causing the patient’s pain. Summary: The doctor must fully listen to the patient’s concerns to be able to identify what is causing the patient’s pain. The most important element is understanding the patient’s distress and concerns.
2. History of Present Illness (HPI)
Important questions: When did symptoms begin to occur? What makes it feel better and what activity makes it feel worse? Have similar episodes happened before? What are your concerns/fears? Goal: To identify where pain is coming from, what triggers the distress, and if the patient has any more relevant details to add color to their story. Summary: The doctor must ask straightforward questions to get all relevant details to understand the patient’s symptoms, concerns, activity level, etc. The doctor needs to know everything about the chief complaint and all the details.
3. Past Medical History (PMH) Important questions: Any recent hospitalizations, surgeries, or special doctor visits? Are you/have you taken any medication? Are you up to date on vaccinations? Do you have any active health problems or other diagnosed pain? Do you have allergies, if so, to what? Goal: To understand the patient’s medical background and get a broader picture of what the patient is or has been treated for. Summary: The doctor must ask straightforward questions to understand the patient’s history and ensure they are aware of past and current medical conditions.
4. Family History (FH) Important questions: Are you aware of any illnesses that run in your family? Have any of your immediate family members suffered from a serious medical condition? Goal: To identify any hereditary traits or conditions that could be affecting the patient’s health. Summary: The doctor must be aware of hereditary conditions and the family’s lifestyle to determine if the patient is at an elevated risk.
5. Social History (SH)
Important questions: Where do you live? What do you do for work? Do you currently live with your family or are you in a relationship? Follow up: Have you ever been kicked, hit, punched, or otherwise hurt by someone in the past year? Do you feel safe in your current relationships? Have you experienced any stressors lately? Do you enjoy working out frequently? How is your nutrition and diet? Do you get at least 8 hours of sleep every night? Are you religious? Do you smoke, drink, or do any drugs? Have you been feeling down or hopeless lately? Are you sexually active? Goal: To see a more holistic view of your patient and understand what their life is like on a regular basis, and these answers often can help explain someone’s medical history and or lifestyle. Summary: The doctor must get all relevant details to understand the patient’s lifestyle and living situation. The doctor also must screen for the patient’s safety (mentally or physically).
6. Review of Systems (ROS) Important questions: Any change in appetite, weight loss, racing heart, or chest pain? Have you recently experienced blurry vision, dizziness, headaches? Any shortness of breath or mucus? Any vomiting? Any abdominal pain, swelling, joint pain? Do you feel any depression or have suicidal thoughts? Are there any other symptoms I should be made aware of? Goal: To review an in-depth list of all the general symptoms associated with different body functions. This can help with diagnosis and treatment. Summary: The doctor must confirm all symptoms and look for overlap that affects multiple body systems.
7. Closing Important questions: Any last thoughts? To confirm, [restate story]. Is this true? Anything to add? Goal: To summarize and review the information with the patient. Summary: The doctor must confirm that all their details are correct, and make sure they did not miss anything.
BY: Kenedy Quandt