The following points are listed to enable you to take an organized history of the patient.
- Start with open questions and progress to closed questions throughout the history taking eg. What brought you in here today?
- Build a rapport with the patient.
- Use signposting: mention what you just covered and use it to link with what you want to talk about next (e.g. so you’ve told me your recent cough, next I’d like to talk about other medical conditions you have had in the past)
- Show empathy
If during history taking you noticed the patient is in pain - empathy: I can see you are in pain, please bear with me for a few minutes and I will give you pain medication as soon as I can
- In the short cases (5 minutes) - use at least 1-2 empathy statements
- In the long cases (10 minutes) - use at least 3 empathy statements
- The patient says “I’m not ok / I’m not so good” - I am sorry to hear that.
- The patient says “I fell down” - Oh, did you hurt yourself? / “No” – I am glad to hear that.
- After the suicide attempt - It looks like you have gone through difficult times, can you tell me more about these difficulties you are facing?
- The patient is regaining consciousness in the ER - Mr ... you have had ... and you are in the hospital now, you are ok now, I am Dr ... and we are here to make sure you’re ok.
I have a concern!
- Whenever the patient says: “I have a concern”: STOP the interview!
- Can you tell me your concerns!
- Why are you concerned?
Whenever the patient shows non-verbal clues of being worried/occupied:
- I can see that you are worried/occupied! Would you like to tell me more about your worries or concerns?
- Respond to cues
- It is really important to listen to what patients are saying, don’t try and think of the next question.
- Cues may be verbal or body language
- Comment on it e.g. you look worried
- After you hear a cue, repeat it back to the patient and then ask more about it (e.g. you mentioned that sometimes you feel down, can you tell me more about that?)
- Whenever the patient says: “I have a concern!”: It is important to investigate further before moving on. Can you tell me your concerns? Why are you concerned?
Breaking bad news (SPIKES)
This unfortunate acronym nevertheless helps memorize the steps and consider their elements
- STEP 1: SETTING UP the Interview
- STEP 2: Assessing the Patient’s PERCEPTION
- STEP 3: Obtaining the Patient’s INVITATION
- STEP 4: Giving KNOWLEDGE and Information to the Patient
- STEP 5: Addressing the Patient’s EMOTIONS with empathic responses
- STEP 6: Strategy and Summary
How to structure explanations
Explaining a disease
- Normal anatomy/physiology
- What the disease is
- Problems it causes and complications
Explaining a procedure
- Explain what it is
- Reason for it
- Explain procedure details (before, during, after)
- Risks and benefits
(If you are asked to also get consent: thoroughly check their understanding, get them to weigh up the pros and cons and ask them why they chose their answer .)