Social history

Question 1

Components of social history

Answer 1

1. Personal history- education, work history and financial status
2. Support history- who is supporting- husband/wife/children/friends, caring for anyone, services, transportation/ still driving? and GP as well as specialist.Pharmaceutical support, NDIS support
   3.Home environment- house- single/double storey, steps front, into room, ensuite rails and equipment. Pets and farms ( how big?)
   4.Personal ADL- self/ need assist, Domestic ADL- cooking/cleaning/gardening, Instituitional ADL- finance, home loan, bills. ( Nutrition can be asked if there is any weightloss >10% in 6 months or excessive weight gain)
3. Insight- Advance health directive, will, EPA and EPG. Where patient think he will be in 5 years? Prognosis?
4. Hobby, sex practices and no. of partners, travel and future pregnancies ( thoughts on sperm banking and eggs preservations for future IVF in relevant cases) and medications compliances especially relevant in HIV cases.
5. Health surveillance- cancer Male- Prostate, female- breast and cervical, both- colon , Vaccinations- COVID, pneumovax.
6. Risk to health- smoking, ETOH, IVDU and other recreational drugs, activity (multiple sexual partner).
7. Depression screening-
8. Dementia and delerium screening- count 20 backward, spell WORLD backwards, AMT4 questionaires and 4AT screening tool for delerium and cognitive impairment ( 4 cardinal features of delerium- acute onset and fluctuating, inattention, Disorganized thinking, altered level of consciousness)

Question 2

Support history

Answer 2

• Who lives with you at home? Do you care for this person? Does he/she cares for you?
• Is this person fit/ well?
  -Is there anyone else helping? Children/son/daughter/support worker/ services for pADL, dADL, iADL ( opportunity to ask about personal, domestic and institutional ADL)
  -Who drives patient to medical appointments ? Self drive- ask about hypoglycaemia during driving if patient on Insulin and using injectables and still on sulphonylureas, Husband/wife/friends/NDIS support/ taxi vouchers
• Does patient get good support / relationship from GP, specialist, pharmacy and support groups?

Question 3

Personal history

Answer 3

-Education level
-work history plus (exposure to environment at work place that increase risk- farmers ( organophosphate poisoning) mining ( coal), building industry ( asbestos),
- Finances- any difficulty, frauds, issues with relatives re: money, house ownerships

Question 4

Home environment

Answer 4

1. Where do you live? House, apartment, farms ( if farms ask for how big and any animals that need caring?) Any pets?
2. How do you get in? steps in front and back to hang laundry if patient does self, any lift access and stairs to floor
3. How many level are there? single house, double storey house, 8th floor apartment. Ensuite and bedroom access on same floor?
4. Are there support rails and equipment in bathroom, shower and toilet?
5. Personal ADL- self vs needing help from family/support/shower services
6. Domestic ADL- who does the vacuuming, mopping and bathroom clean =/- gardening
7. Institutional ADL- who does the bill paying, banking?

Question 5

Insight

Answer 5

1. Do you have a Will, Advance health directive, EPA ( Eternal power of Attorney allocated to NOK, daughter/son), EPG ( Eternal power of guardianship)
2. Where do you think you will be in 5 years?
3. What is the most pressing issue with your health at the moment?
4. Which medical problem that you feel is affecting you, your psychological well being and is most concerning to you?
5. What do you think the doctors are worried about ?

Question 6

Hobby, Sex practices, partners, travel and future pregnancies/children ( view of sperm banking, eggs preservation and IVF) and compliance with medications, practices

Answer 6

1. Do you have any hobbies? What is stopping you from doing this?
   Are you able to enjoy this currently?
2. Do you have any sexual partners? ( Especially in MSM, homosexual and LGBT group), How many? Do have anal sex? Do you erectile dysfunction? DOes it bother you that you have ED? Do you /does partner take any pre-exposure prophyaxis? DO you use condom?
3. Travel - do you travel, when was the last time, which country? Country of origin? Previous infections - malaria etc
4. Do you have any plan to get pregnant? Have you performed sperm banking? Have you preserved any eggs for future pregnancies? How many kids are you planning in the future - if relevant?- incases using immunosupressive agent that are carcinogenic

5.How many pills do you miss a week/ a months? What do you do when you miss a pill?
- >2 missed pill a month for HIV meds is < 90% adherence if I am not mistaken…..
- 2 pills missed = 93% adherent
- can also ask, how often do you fill in your prescription, once/ month/ 3 months/ 6 months?
- uses webster pack, pill box ( who organises the box), can patient remember name and dose and when to take it, any pill reminder on phone, medication reminder via phone call.

Question 7

Health surveillance

Answer 7

1. Cancer screening
   -Skin cancer, anal cancer in HIV patients, PTLD screening questions for post transplant pts.
   -Woman- are you UTD with your cervical cancer screening? ( relevant in women aged….)
   - When was your last mammogram? Are you UTD with this?
   - Have you done the Fecal occult blood test kit from the government? Have you
   had any colonoscopy? When was the last one performed?
   - Men- Prostate cancer- has your GP check your prostate cancer level or PSA?
   - Do you have any issue with prostatism ( difficulty starting, blood in urine and pain?)

2.Vaccination-need to look up vaccination guideline now.
- who is not eligible for live vaccine?
-pneumovax, COVID

Question 8

Risk to health

Answer 8

1. Do you smoke? How many cigarrette /day? Do you smoke first thing on getting up or within 10 mins of getting up?
2. Do you drink ETOH? How much? What type? beer/wine/whisky.
   Has anyone told you that you drink too much? Does you wife/hubby says that? Do you miss work from hangover? Have you been caught drink driving? Have you been to prison for any reason?
3. Do you inject yourself with hallucinogen? Have you sniff coccaine? Inject methamphetamine? Do you smoke/take marijuana?
4. Do you have sex with someone you just met? How many sexual partner do you have in the last 3 months? ( in HIV cases)

Question 9

Depression screening

Answer 9

A SAD FACES-
Anhedonia- do you feel low in your mood?
Sleep disturbance- do you have insomnia, night waking or difficulty sleeping?
Appetite- Do you like eating, do you have any difficulty tasting, enjoying food? How many times/day do you eat? DO you think you have a balance diet
Dysphoria- do you feel
Fatigue- Are you tired all the time and need more sleep than other people.
Agitation/ retardation-do you get agitated easily, do you find it slow to process information than usually?
Concentration - do you find it hard to concentrate and focus on task?
Esteem low- do you think life is worth living or not? DO you feel sad and feel judge by other people?
Suicidal thoughts- attempt. DO you have any thought about harming yourself or committing suicide?

Question 10

Dementia and delerium screening

Answer 10

AMT4- ask about 1. Age
2. DOB- difficult in exam cause you dont their DOB
3. PLACE
4. YEAR

4AT- 1. ALertness- your subjective assessment- drowsy, sleep, alert
2. Answering AMT4 question above correctly ( 0 for no mistakes, 1 for 1 mistake, 2
score for more than 2 mistakes)
3. Attention- 20-1 count backwards, Pease tell me the months of the year backwards
starting from December ( achieves 7 months or more correctly- 0 score, gets < 7
months- score 1, untestable as unwell, drowsy, inattentive- score 2)
4. ACute change or fluctuating course- NO- score 0, YES- score 4.
Score 0- delerium /sever cognitive impairment unlikely
Score 1-3- possible cognitive impairment
Score 4 or above- possible delerium and cognitive impairment.