First most important question to ask

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Brian

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Can't find a definitive answer online or in my text for this one, so I'm hoping maybe someone can help me out... What is the single most important question to ask in the SAMPLE history? I say it would be signs and symptoms, a classmate says past medical history. We've been going round and round on this, can anyone clarify for us? Thanks in advance.
 
Getting a name is usually a good idea... and just asking what's going on, if it's not glaringly obvious.

"What brings us here today?"

If you want to examine it in textbook terms, you're weeding out their chief complaint, and signs and symptoms.

You will find that talking to patients in real life is very different from your tests. If you assess a patient in the real world and follow SAMPLE step-by-step by the book, you will sound like an idiot. It can be useful as a template/crutch when you're first starting out to help you remember to hit all the key points, but your patient's answers and situation should ultimately guide your assessment and questions, not an acronym.
 
"Is that a real Rolex?"

"Are you taking any meds? Are you allergic to any meds? What happened?". Yes/no, yes/no, then a story while you take VS and observe for mental status, respiration while talking, and sneak a closer look at the watch.

I can treat you without your name, I can kill you without your meds and allergies and c/o.
 
mycrofft said:

I can treat you without your name, I can kill you without your meds and allergies and c/o.
Click to expand...

Of course, but 98% of the time there's no excuse not to get your patient's name, and I would be extremely irritated as a patient if my care provider didn't bother to ask. Referring to someone by their name builds rapport.
 
"Hi there, I am Brown and this is Blue, whats going on today?"
 
"Hey, wake up, I need your name"...of course you are right, But so am I.

Before you dip the mark's wallet to check ID, make sure he's unconcsious or he'll nail you.
 
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LucidResq said:
Of course, but 98% of the time there's no excuse not to get your patient's name, and I would be extremely irritated as a patient if my care provider didn't bother to ask. Referring to someone by their name builds rapport.
Click to expand...

So, I'm not supposed to just assume that my patient's name is Jane Doe?
 
Will this be cash or credit?

Really though, I like to start with:

"What made you call us today?"

or in the hospital:

"what brings you to our humble abode?"
 
Brian said:
Can't find a definitive answer online or in my text for this one, so I'm hoping maybe someone can help me out... What is the single most important question to ask in the SAMPLE history? I say it would be signs and symptoms, a classmate says past medical history. We've been going round and round on this, can anyone clarify for us? Thanks in advance.
Click to expand...
"Are you sure the dog is tied up?"
 
My preferred introduction during the course of my extensive experience has been:

G'day, I'm Melclin, this is my partner Barnaby Joyce, what can we do for you.

At uni, people will often introduce themselves: "Hi, I'm Esmarelda from the Ambulance service." and I always think.. they've called 000 for an ambulance, you've turned up in an unambiguous uniform with paramedic stamped all over it, carrying a bunch of medical stuff and there's a bloody great ambulance parked in the driveway... I think they're ganna get that you're from the ambulance service. Haha. (I do realise there may be many good reasons for announcing yourself but I just thought it was a mildly humorous observation).

While I don't know that you could say that any particular question is the MOST important, it seems to me that one of some considerable importance is the kind that queries the normality of the presentation, "Is this how your chest pain normally is", "Is this what Kevin is usually like during his psychotic episodes", "Is Barry usually a quiet baby".

Also, I'm terrible with names, a trait that I'm trying to improve, but for me, male patients are 'mate' and female pts are 'love' until proven otherwise. Mothers are 'Mum', Fathers are 'Dad' and anyone smaller than me is 'little tacker'. B)
 
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EMERGENCY is about NOW

"What's going on with you Right NOW?"

The most important moment is the one in front of you. You can always back track.
 
Thanks for all the feedback everyone, Firetender I'm inclined to agree that asking what's wrong right now is the most important thing, especially since it establishes the PT's chief complaint. Asking about meds might be a good start also, but could also send you in the wrong direction in the treatment of a patient.
 
Im terrible with names. I can remeber everything else vitals, meds and allergies. I rarely write anything down.

Never can remember a name. I always revert to mam or sir.
 
I agree, try and get their name, get a chief complaint, and then just start treating/asking as you go along.
 
How are you paying for this? ;)
 
Rephrase the question. You have one minute of diminishing pt. consciousness.

Allowing for time for the increasingly obtunded pt to think then reply, NOW tell us what the most important question(s) is/are.
Honest answers to these could be a real psychological test.
 
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