Clinical Comms 3 - Taking a Social History

Question 1

What is social history?

Answer 1

• Occupation “do you work” not “What’s your job”
• Living situation
• Sexual history
• Travel
• Stress
• Physical activity
• Diet and exercise

Question 2

What is important to avoid?

Answer 2

• Being judgemental (dont say “do you drink much”)
• Keep questions open (“Who’s at home with you” not are you married)
• “We ask all our patients this” - be careful
• Don’t assume

Question 3

Alcohol history

Answer 3

• Ask everyone
• Do you drink, how much in an average week. Suggest a range
• Ask separately about beer, wine and spirits
• 1 unit= half a glass of wine, half pint of beer, one measure of spirits (but alcohol is getting stronger)
• 14 units a week recommended (spread across the week not every day
• Binge drinking - 6 units for a woman and 8 for a man in one sitting
• AUDIT-C (alcohol use disorders identification test - how often, units typical day, how often binge drinking)

unit=(Alcohol by volume x volume in ml)/1000

Question 4

Smoking history

Answer 4

• Ask everyone
• Do you smoke?
• Have you ever smoked?
• How long ago, how long for, how many cigarettes a day, why did you stop, what do you smoke (cigarettes, filter/roll ups)
• Pack years - packs smoked a day (20 in a pack) x years as a smoker

Question 5

Drug use history

Answer 5

• Ask everyone now, doctors don’t
• Signpost (is it ok if I ask about… routine question…)
• Have you ever taken recreational drugs? (Confidentiality - not used)
• Don’t react (ask what else)
• When do you use it, how often
• Medication or social history

Question 6

Diet and exercise

Answer 6

• Ask people who will benefit (related illnesses, people who look over or underweight, where vegan diet may affect illness)
• Can you talk me through what you eat in a day? (5 a day)
• Vegan/ vegetarian
• Any dietary restrictions?
• Physical activity (not exercise)
• Have you noticed any weight gain/loss, do you know what your weight is, how do you feel about it, use BMI chart?
• ACTS (can I ask about your weight, any concerns, typical days food, any special diet)

Question 7

Sexual history

Answer 7

• Signposting (is it alright if I ask you some questions about your sex life - say why you want to find out about it eg. illness affecting relationships)
• Do not ask all your patients
• Contraceptive pill/pregnancy
• Urinary or abdominal pain
• Non-judgemental
• No assumptions (is your partner a man or woman)