History & Clinical Interviewing Dr Vivek Joshi, MD

History Physical Examination Reports of Investigations and Lab data Differential Diagnosis Diagnostic plan Therapeutic plan Parts of the patient record

The "Classic" History  ID- Identifying Data  CC - Chief Complaint  HPI - History of Present Illness  PMH - Past Medical History  SH/OH/FH - Social, Occupational, Family History  ROS - Review of Systems

Health History History: Information obtained from the Patient Chronological record of patient’s symptoms from inception of Illness until he presents himself to a physician Without history, Physical exam is a routine mechanical procedure No field of medicine is history taking not essential Art of history taking cultivated to the highest degree

Listening Listen Zuhören Luisteren Entendre Escuchar Ascoltare слушать Α κροώμαι Isma للاستماع Shema 听 [t ī ng]

Symptoms Patient Consults a Physician because of Unpleasant or unusual Subjective Sensation- (Symptoms) Interferes with His/Her Comfort or Productivity

Initially: Introduce yourself (last name) to the patient State your name and role in the process Address the patient properly (last name)

Source of History: Patient Demographics:  Name  Age or DOB  Gender  Religion/race  Occupation  Address History: Identifying data

FUNCTIONS OF THE MEDICAL INTERVIEW? TO GATHER INFORMATION TO FORM A RELATIONSHIP WITH PATIENT TO EDUCATE THE PATIENT

Start Your Interview A greeting “Hello” Mrs. Jones, I am Dr. Joshi “Good Morning” “How are You Today?” What Problem Has Brought You to See Me Today? The Answer is the Chief Complaint

All the symptoms in patients own words Also note the duration of appearance/disappearance Don’t use medical terminologies Chief complaints

Sentence or phrase conveys main reason for patient’s seeking health care quote the patient’s own words “Low Back Pain” “Frequent headaches” “Chest Pain” “Nausea and vomiting” Failure to obtain an Accurate Chief Complaint can lead to incorrect Diagnosis Chief Complaint (CC)

document patients symptoms in chronological order in form of a story Each symptom should be in separate paragraph with description of the symptom. What immediate measures were taken to relieve the symptoms History of present symptoms

Commonly asked questions Site Onset Character Radiation Associated factors Timing Excerberating and Relieving factors Severity

Onset Location Timing/Duration Radiation Quality Quantity Setting Aggravating Factors Relieving Factors Treatments tried Associated Symptoms Effect on Function (life) When dealing with pain, ASK!

Childhood Illness Adult Illness  Medical  Surgical  Obstetric /Gynecological Immunizations Past History

Illness and cause of death in immediate family members Pedigree chart Important in genetic diseases or lifestyle based diseases Family History

Lifestyle Habits and addictions Education and job satisfaction Family life and Sexual life Diet and exercise Financial situations Social and religious well being Personal and Social history

Short questions where the patient can answer in “Yes” or “ No” Set of questions focusing each systems Review of system

Vitals and general survey Focused examination Physical Examination

Its is skilled process of getting relevant information from the patient which can help in the rendering service to the patient. Clinical Interviewing

Active listening Empathic response Guided questioning Non verbal communication Fundamentals of skilled interviewing

Validation Reassurance Partnering Summarization

Transitions Empowering patient

Preparation. Greeting patient and establishing rapport. Establishing Agenda Inviting Patient story and exploring patient perspective (FIFE) Sequence of Interview

Identifying and responding to the patients Emotional cues Expanding and clarifying the patient’s story Generating and Testing Diagnostic Hypotheses.

Sharing treatment plan. Closing the interview Taking time for self reflection

Thank You