The Patient’s Story: history of past medical problems Seki A. Balogun, MD, FACP Practice of Medicine-1

Objectives Describe the structure of the medical interview Describe the content of aspects of the medical interview Demonstrate eliciting the patient story

Content of the Medical Interview Chief Complaint HPI Other Active Problems Past Medical History Family History Social History Sexual history Review of Systems (ROS)

Who Controls the Interview? Patient- centered Doctor- centered Time

Interview Styles FacilitatorsInterruptions Directive questions Silence Patient Centered Doctor Centered

Challenges to Overcome Balancing competing opportunities Time Tailoring interview nature of chief complaint/presenting problem patient’s demographic characteristics Transitioning Using communication skills

Past Medical History: Content Major illnesses Hospitalizations Surgeries Significant injuries Medications Allergies Immunizations Gynecologic and obstetric history (women)

Family History Current health of family Specific familial diseases Other family members with similar illnesses

Social History - Patient Profile How do lifestyle or personality traits: Contribute to illness? Aggravate or limit severity of illness Interfere or help with getting well. Impact activities of daily living

Social History Relationships Occupation Education military Health Habits Smoking, Alcohol, Recreational drug use Exercise Diet Spiritual, cultural and health beliefs