How to use this book

Medical students are usually pretty good at following the history template:

Presenting complaint
History of presenting complaint
Systems review
Past medical history
Drug history
Family history
Social history, including “Ideas, Concerns and Expectations”

This section provides a template of key questions addressing each cause (risk factors) and effect (symptoms) of pathologies for a particular system. You should still follow the traditional history template, but have these in the back of your mind. These questions can also be used for systems review and if answered in the positive, you can ask further questions to flesh out the details

Tips for history taking:

1. Know what is important and bring it to the front

Unfortunately, key questions are often missed out of the HPC. Important facts that fall under other categories are also frequently forgotten (e.g. cardiac risk factors are left scattered and hidden in the depths of family, past medical and social history).

2. Be flexible

Taking the history itself is not a linear progression through a template. Rather listen out for clues patients give, follow them up and then return to the initial thread. Click here for an example for a history of chest pain.

3. Construct a timeline

It is useful to be able to draw a timeline of symptoms.

E.g. A patient presenting with SOB

SOB started six days ago, followed by a productive cough. Over the last four days SOB has been increasing and cough has been productive of initially yellow, now green sputum (no blood). Two days ago the GP started amoxicillin, with no response.

4. You might not be the first doctor they’ve consulted

Try to find out exactly what investigations the patient has had in the past and how they responded to any treatment they might have already been given.

5. Quantify as much as possible

Objective measuring allows you to track the patient’s progress. Severity scales are provided in this book where practical and validated. E.g. New York Heart Association Class for heart failure.





Thinking Medicine