History taking

Question 1

Difference between history taking and clerking? When do we use each of them?

Answer 1

History taking is consultation skill involving focussed information gathering and deductive reasoning - used when we don’t know the patient and we need to find out as much info as possible.

Clerking is an information gathering process which is relatively indiscriminate - used in hospital setting when we are gathering info in a structured way

Question 2

7 key components in classical medical clerking?

Answer 2

1. Presenting complaint
2. History of presenting complaint
3. Past medical history
4. Drug allergy
5. Family history - pt comes with abdo pain, do their family have abdo pain
6. Social History - alcohol, smoking, illicit substances, occupation, who they live with - elderly living alone, mental health pt living alone?
7. Review of systems - target the systematic review dependent on symptoms.

Question 3

What system would you expect to be affected if a patient presented with these symptoms:
chest pain, ankle swelling, palpitations.

Answer 3

Cardiovascular

Question 4

What system would you expect to be affected if a patient presented with these symptoms:
cough, haemoptysis, wheezing

Answer 4

Respiratory

Question 5

What system would you expect to be affected if a patient presented with these symptoms:
change in weight, heart burn, abdominal pain

Answer 5

Gastrointestinal

Question 6

What system would you expect to be affected if a patient presented with these symptoms:
frequency in urination, urethral discharge, incontinence

Answer 6

Genitourinary

Question 7

What system would you expect to be affected if a patient presented with these symptoms:
visual disturbance, facial numbness, deafness, limb motor symptoms

Answer 7

Cranial nerve symptoms

Question 8

What system would you expect to be affected if a patient presented with these symptoms:
bone or joint pain

Answer 8

musculoskeletal

Question 9

How can we ensure we are giving a patient space to talk?

Answer 9

As open questions

Question 10

What is conformational bias?

Answer 10

Once you have formed an opinion, you have a tendency to only notice the evidence that supports you and ignore contrary evidence. For example, a patient might present with a throbbing unilateral headache, photophobia, and nausea that makes you think about migraines and then we can miss out on vital information

Question 11

How can we check understanding after a consultation with a patient?

Answer 11

Summarise during and after consultation

Ask the patient what they are going to do next