Take a history

Take a history

/uni25CF Presenting complaint . Start with an open-ended question. Ask the patient to ‘explain what the problem is’ in their own words and ask the patient what their hopes and expectations are from the interview . /uni25CF History of the presenting complaint (‘the three Ws’) . W hen did you first notice the problem? W hat were you doing when it started? W as the onset sudden or did it develop gradually? /uni25CF Associated symptoms . Ask about the following: pain; swelling; instability – ‘giving way’; mechanical symptoms (e.g. locking, clicking, clunking); loss of power; altered sensation. /uni25CF Functional impairment . Ask whether the patient is having di ffi culties performing activities of daily living: upper limb, e.g. personal hygiene, feeding; lower limb, e.g. putting on shoes and socks, standing, walking and climbing stairs. /uni25CF Past medical history (PMH) . Check for comorbid conditions which may contribute to the presenting problem or a ff ect the patient’s fitness for an anaesthetic, e.g. diabetes, asthma, previous heart attack or stroke. Check for any previous problems with anaesthesia. /uni25CF Past surgical history . Ask about relevant surgical procedures. /uni25CF Drug history . Ask about all medication and the following in particular: anticoagulants, steroids, aspirin, immunosuppressant therapy , oral contraceptive pill and hormone replacement therapy . - /uni25CF Social history . Tailor questions to the patient’s condition: patient’s age; hand dominance; employment status; dependants; alcohol consumption; smoking; hobbies; home help; accommodation – own house, residential or nursing home; use of walking aids; mental test score assessment. /uni25CF Family history . This may reveal a history of MSK disease. Summary box 35.1 Taking a history /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF

Use and interpret special tests • Use /f_i ndings to understand the impact on a patient’s pain • and function Introduce yourself and put the patient at ease Explain what you are doing and ensure that the patient agrees Start with an open question to understand the presenting complaint Check for history of the presenting complaint and associated symptoms Ask about functional impairment Check past medical history and relevant surgical and family history Check drug and social history

Take a history

/uni25CF Presenting complaint . Start with an open-ended question. Ask the patient to ‘explain what the problem is’ in their own words and ask the patient what their hopes and expectations are from the interview . /uni25CF History of the presenting complaint (‘the three Ws’) . W hen did you first notice the problem? W hat were you doing when it started? W as the onset sudden or did it develop gradually? /uni25CF Associated symptoms . Ask about the following: pain; swelling; instability – ‘giving way’; mechanical symptoms (e.g. locking, clicking, clunking); loss of power; altered sensation. /uni25CF Functional impairment . Ask whether the patient is having di ffi culties performing activities of daily living: upper limb, e.g. personal hygiene, feeding; lower limb, e.g. putting on shoes and socks, standing, walking and climbing stairs. /uni25CF Past medical history (PMH) . Check for comorbid conditions which may contribute to the presenting problem or a ff ect the patient’s fitness for an anaesthetic, e.g. diabetes, asthma, previous heart attack or stroke. Check for any previous problems with anaesthesia. /uni25CF Past surgical history . Ask about relevant surgical procedures. /uni25CF Drug history . Ask about all medication and the following in particular: anticoagulants, steroids, aspirin, immunosuppressant therapy , oral contraceptive pill and hormone replacement therapy . - /uni25CF Social history . Tailor questions to the patient’s condition: patient’s age; hand dominance; employment status; dependants; alcohol consumption; smoking; hobbies; home help; accommodation – own house, residential or nursing home; use of walking aids; mental test score assessment. /uni25CF Family history . This may reveal a history of MSK disease. Summary box 35.1 Taking a history /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF

Use and interpret special tests • Use /f_i ndings to understand the impact on a patient’s pain • and function Introduce yourself and put the patient at ease Explain what you are doing and ensure that the patient agrees Start with an open question to understand the presenting complaint Check for history of the presenting complaint and associated symptoms Ask about functional impairment Check past medical history and relevant surgical and family history Check drug and social history