Taking histories, do you routinely ask about:

mycrofft

mycrofft

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1. When was your most recent menstrual period? ("latest" and "last" can have different meanings, referring to late periods or final menstruations).
2. Are you taking any of your prescriptions which have run out or are outdated?
3. Are you taking any medicines (don't say "drugs") which are prescribed for other people?
4. Are you taking over the counter medicines, herbal or "natural" remedies, or frequently drinking herbal teas on a daily basis? How long? How much? *

I have observed that these questions are not asked when there is time because of embarrassment, or the pt dodges the question, or hurried techs think "Are you taking any meds?" is enough.

Any stories about surprising histories like that? How about tips to get around pt reticence? Or caregivers of a non-communicative patient?


* "Aw, c'mon man, this is supposed to be about knives and flashlights and driving fast the wrong way with sirens...";)
 
I really enjoy the "any chance you could be pregnant?" dance. Usually a winning quote every time.
 
A lot of the questions I ask are based on the patients C/C. So it changes from patient to patient.
 
firefite said:
A lot of the questions I ask are based on the patients C/C. So it changes from patient to patient.
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Yes, this. But if I want to specifically know about any and all substances the patient might have ingested, those are the questions I ask.
 
abckidsmom said:
I really enjoy the "any chance you could be pregnant?" dance. Usually a winning quote every time.
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I don't even ask this anymore, all females between the ages of 9 and 65 are pregnant until proven otherwise by HCG, a scar with a hx of hysterectomy, or the lady states she had a transvaginal hysterectomy. (which is a fairly new procedure so not likely to be seen in older women.)
 
People aren't very forth coming with info. So like others have said. Depending on the chief complaint I will ask very specific questions.
 
mycrofft said:
1. When was your most recent menstrual period?
2. Are you taking any of your prescriptions which have run out or are outdated?
3. Are you taking any medicines (don't say "drugs") which are prescribed for other people?
4. Are you taking over the counter medicines, herbal or "natural" remedies, or frequently drinking herbal teas on a daily basis? How long? How much?
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1. Yes, for females complaining about something in that region. And some guys, just to lighten the mood, because I'm awesome like that.

2. Not typically, unless when looking at the meds I see some are out-of-date or multiple bottles of the same med.

3. If it comes up, yes.

4. Yes



And I mix in "Is your poop / pee normal, normal color, normal smell", etc etc.
 
Linuss said:
1. Yes, for females complaining about something in that region. And some guys, just to lighten the mood, because I'm awesome like that.

2. Not typically, unless when looking at the meds I see some are out-of-date or multiple bottles of the same med.

3. If it comes up, yes.

4. Yes



And I mix in "Is your poop / pee normal, normal color, normal smell", etc etc.
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This... And sometime add in asking if any of their medications had been changed recently
 
I ask detailed questions about meds when it matters in the hospital or clinic. But if they are in for an unrelated thing, I generally gloss over it. In the clinic I generally do a review of meds for all patients based on their chart, but won't pester and prod them for more unless I think it's relevant (otherwise we just annoy the majority of our patients).

I don't do this in EMS, i just ask for a list of their meds or ask about them one by one finishing each with "anything else?"
 
abckidsmom said:
I really enjoy the "any chance you could be pregnant?" dance. Usually a winning quote every time.
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Me: Any chance you could be pregnant?
Pt: No.
Me: Are you sexually active?
Pt: Yes.
Me: Are you using any methods of birth control?
Pt: No.
Me: The answer, then, to my first question, would be a "yes". Just because you don't want it to be true, doesn't me that's the case. :rolleyes:
 
I usually insert a "have you been abducted by aliens recently," when patients are answering strings of questions with lots of yeses or nos. I do it for humor, but every now and then I get a considered pause and a yes answer...:ph34r:
 
I think everyone has good ways to get answers out of patients. I really dislike the new EMT questions, "do you have any medical history I should know about?"

I tend to look at the med list and key off the meds. "I see you take lisinopril, you see your doctor for high blood pressure?" When I get a yes, I follow up with, "So, what else have you been seeing your doctor about?"

I ask about the supplements, other medications and herbal remedies a lot here. My area is a backwoods, so we get a lot of people treating themselves with the same meds they use on their cows and chickens...
 
For patients with a lengthy medical history (assisted living facilities generally), I sometimes will ask if they have been taken by ambulance or gone to the emergency room in the last few months or year for something similar. Asking "what do you see your doctor" can elicit information that will take the whole call to process.
 
That's way too complicated sometimes. Asking about meds???
They don't even know what's wrong with them, let alone what they take for it.
'I don't know. The doctor says take it. I don't know what for.'
'What's 'it''?
'The little(describes the pill), you know'
Ahhh, yes. It's all so clear to me know.

I dumb it down.
'Any heart problems?'
'Yeah'
'What did the doctor say is wrong with your heart?'
'I dunno. I don't remember. Something.'
After leading them...CAD, CHF, MI, etc. nothing rings a bell. And why should it? It's only their heart, right?

'Where did that scar come from?'(zipper chest)
'Heart'
'Heart what?'
'I don't know. They cut me open and did something'
'Sounds fabulous. Ok, ready to go?'

Sigh. It's a comedy show.
 
I ask all those questions at different times. It all depends upon why I am there and what I have been told the problem is (if it isn't obvious). I will also wait until we are in the ambulance to ask more personal questions, especially of teens, so they aren't embarrassed in front of their family.

I also have to admit it drives me absolutely bonkers when people have no clue why they are taking a medication. I admit I don't know dosages for everything I take, but I can list off every med and why I take it. (And, I am not referring to patients that have unreliable memories for whatever reason. I am talking about the relatively "normal" middle aged adult.)
 
Trashtruck, you also have to love the conversations that go like this:

Patient: No, I don't have any sort of history.

EMS: I see you are taking Metoprolol. Do you have high blood pressure.

Patient: No. No, I don't have that.

EMS: But that medication is used to treat high blood pressure. Are you sure you don't have it?

Patient: Well, I guess I did have it, but I don't have it any more because I have been taking the pills the doctor gave to me.
 
Epi-do said:
Trashtruck, you also have to love the conversations that go like this:

Patient: No, I don't have any sort of history.

EMS: I see you are taking Metoprolol. Do you have high blood pressure.

Patient: No. No, I don't have that.

EMS: But that medication is used to treat high blood pressure. Are you sure you don't have it?

Patient: Well, I guess I did have it, but I don't have it any more because I have been taking the pills the doctor gave to me.
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I had a patient say "I had 6 stents in my heart."

I asked what he meant by "had"

He said "they started hurting me a couple of days ago so I pulled them all out".
 
n7lxi said:
My area is a backwoods, so we get a lot of people treating themselves with the same meds they use on their cows and chickens...
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I grew up on a dairy farm, and we were known to use the farm meds occasionally for human use. Does that make me an animal?:P

Seriously though, many of the medications used in agriculture, at least in dairy, are human medications packaged for animal use.

But I understand what you're saying, and it's a wise line of questioning.....
 
Not at all, but here you may not find the meds in the bathroom or in the kitchen, instead they're out in the tack room. :)
 
mycrofft said:
1. When was your most recent menstrual period? ("latest" and "last" can have different meanings, referring to late periods or final menstruations).
2. Are you taking any of your prescriptions which have run out or are outdated?
3. Are you taking any medicines (don't say "drugs") which are prescribed for other people?
4. Are you taking over the counter medicines, herbal or "natural" remedies, or frequently drinking herbal teas on a daily basis? How long? How much? *
Click to expand...

1. Not often. I'll ask if its relevant but it rarely is. I don't see that many women of that age with complaints relevant to hx like that. Every time I ask, "Is there any chance you could be pregnant?", I wait for a witty reply and I never get one. Its almost always a simple, "Yes"..... I need to start seeing more entertaining patients.

2. I don't specifically about dates. I ask what meds they're taking, then I ask if they're taking them/ took them this morning/this evening. If the answer is know I'll ask why. They're all heavily subsidised by the government so non-compliance is rarely associated with an inability to actually get/afford the drugs.

3. No. Again, probably not so much of an issue here given that both Drs and drugs are essentially free. Its never a line I've considered going down to be honest.

4. I usually ask in a more colloquial way. After I've got all the meds listed I usually cap it off with, "So you don't take any other pills, potions or puffers? Anything at all? Nope?" To be honest though, I'm not that interested in what brand of multi-vitamin they take. Being thorough is good an all, but if they've got chest pain, chances are nobody in the short term will care about their camomile tea or whatever. Maybe it will be relevant at some stage, but I've got a whole lot of other more pressing stuff to think about most of the time.


I've got a lot of standard lines of questioning. I mix and match most of the bellow in most people (seeing as though most people I see are >65yrs old. I wouldn't ask much of this of a 17yr old footballer with a broken ankle) and some pt specific things like last INR, but mostly it involves:

"How's the medical history? Not to bad you reckon? So no health problems at all?

Every had any heart attacks? No? Funny rhythms of the heart where it beats too fast or too slow? Any problems with any of the valves? Even seen a cardiologist? Ever had chest pain?

Ankles ever swell up? Do you get much exercise? Out to the mail box you say? Have you been finding you get more SOB lately doing that? How many pillows do you sleep on? Ever get SOB laying flat?

Any problems with your lungs? No asthma? Emphysema? Been coughing up any junk lately? Smoke? Did you used to? How much did you used to smoke?

How are your kidney's doing? All good? How about the water works? No pain? Funny smells? Frequency? How much water have you had to drink today? And yesterday?

How's the liver? Alright?

Bowel motions normal? Not dark or black at all? Last bowel motion? Any your eating normally? Whats normal for you?

Got diabetes? How do your sugars usually run/what was your last HbA1c?Any stokes or ministrokes? How's the blood pressure? Not bad? What was it last time you the dr took it? Hows the cholesterol?

So you've been in pretty good health in the past sort of 6 months or so? Yep, been into hospital at all in the past few years?"
 
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