Lecture 3, 10 + 19: History Taking

Question 1

What are the Calgary-Cambridge first steps to Hx taking?

Answer 1

1. Open/Initiate the discussion
2. Gather information
3. Understand the patient’s perspective (structure and relationship)

Question 2

What are the agendas of the two perspectives in History taking?

Answer 2

Your agenda: rapport, understand what matters to the patient, get the story –> formulate and test your hypothesis
Patients agenda: do you understand or listen to me, what is wrong, can you help/is there hope?

Question 3

What difficulties may occur in the consultation?

Answer 3

language barrier
talks to little or too much
deaf/dysarthric/dysphasic, language problem –> allow the patient time to speak
delerious/demented

Question 4

What other “witnesses” are there?

Answer 4

note from GP, ambulance, ED, nurse
old notes
bystander/partner/relative/neighbour
bed space (equipment around patients, should examine environment before patient)

Question 5

What is Ockham’s razor?

Answer 5

Usually, symptoms are all due to one diagnosis
–> do a single differential diagnosis for all related symptoms
Note: common things occur commonly (likely –> least likely)

Question 6

What are some possible pitfalls you could do as a clinician?

Answer 6

• Not giving the patient time to think and speak
• Not establishing what matters to the patient
• Closed questions
• Medical jargon
• No questioning enough and just accepting previous diagnosis
• Setting diagnosis too quickly
• Examining a patient WITHOUT A HYPOTHESIS (i.e. before taking an adequate history)

Question 7

What should be some components of the History of Presenting Complaint?

Answer 7

State difficulties with encounter
Use patient quotes as adds value to History
Be wary of vague terms: misunderstanding or total lack of understanding
Socrates
If multiple episodes: describe the last episode and then a typical episode - if they differ

Question 8

Social history

Answer 8

How has this illness affected you?

- Affect on ALDs (activities of daily living)

Question 9

Family history

Answer 9

Illnesses that run in your family

Parents still alive? If not what did they pass away from

Question 10

What are the four aims of a Clinical Examination?

Answer 10

1. Confirm or refute your provisional diagnosis/hypothesis (ie. is guided by the hx)
2. Quantitate the severity of the abnormality of physiological function
3. Determine the affect of the primary disorder on other organs
4. Detect “surprise findings”

Question 11

What are some questions for the HPC?

Answer 11

Can you tell me what has brought you into hospital?
Finish with: Is there anything else you want to tell me, or think I should know? (can be helpful to summarise)
After: formulate or test your hypothesis with further questions + SE questions from relevant symptoms