Patient interviewing Trauma/Medical

[Rialaigh]

The one that I find gives me the best idea of any medical problem and one of the first questions I ask is "when was the last time you were in the hospital". A lot of our patients don't know what CHF is or COPD, if you want to know if they have diabetes or hypertension you ask questions like "do you have high sugar?" or "do you have high blood?".

I would say 95% of the patients we pick up have been seen at the hospital in the last 6 months for the exact complaint or something closely related.


Meds/Allergies is a first along with the hospital question. Last time you ate for any chest pain is also at the top of my list, a very high percentage of the time it is esophageal pain (dispatch and patients can't differentiate) and they have just eaten a burger and have previously been diagnosed with "stomach problems"

I work in a rural county where 95% of the people smoke, drink, and eat like crap with no primary care. Knowing the demographics and statistics medically for the area you work is worth its weight in gold for all the paper you will have to read. Asking to try and access the call analysis or statistics for last year in your area and getting an overview on amount of medical verse trauma, amount of priority 1 into the hospital, amount of CPAP usage and RSI (or intubation) and STEMIS called is a great starting place for understanding the types of questions that will get you the highest and fastest rate of return on questioning.

 

[Ridryder911]

Four parts of a medical examination are:

History

History

History

Detailed physical examination.

This is where medical examination differs from trauma assessment. Usually, one can tell what has happened from the incident (of MOI should be explored) but one usually can easily see what incident caused the trauma.

R/r 911

 

[Melclin]

First is usually introductions and quick look or whatever you want to call it. Specifically look the patient up and down and palpate a radial pulse. You can tell so much in the first 5 seconds this way. Distressed? Diaphoretic? Pallor? Increased WOB? Lethargy? Meaningfully interactive and appropriately responsive? Presence of radial pulse? Strong? Regular? Temp of extremity? Cap refil? Not to mention you are laying hands on the patient and I think it establishes a caring & comforting relationship from the outset.

In essence most of my jobs follow a similar pattern in initial hx taking:
- Chronology of symptoms leading up to calling. "So you got chest pain 2 hours ago? Has it been constant or does it come and go? etc etc
- Current signs and symptoms + read back. "Okay now correct me if I'm wrong, what I'm hearing is that you developed mild central chest pressure at rest 2 hours ago, that subsided to being pain free over the course of about 30 mins, then twenty mins ago you started feeling SOB with no other symptoms, getting worse and now I can see that you're quite sweaty and having some trouble breathing. Does that about cover it?"
-Pertinent negatives. "So lets tick a few boxes, any palpitations right now? Chest pain, pressure or discomfort? Dizzy at all? etc etc

Usually this is pretty concurrent with BP, monitoring, temp etc.

Specifically, I'm a big fan of "Point to the pain". Its amazing how much abdo pain is chest pain and vice versa.

There is the old trick where patients deny medical problems because the issues have been 'fixed'. "Do you have hypertension?" "Nope." "Why are you on this antihypertensive?". "Oh, I used to have high blood pressure, but its better now doctor has me on those pills". So the way you phrase your questions here can be important. Ask the same kind of question in 10 different ways. Any medical problems at all? Medical hx? Have you had any health problems in the past 10 years? See a doctor about anything? Been in hospital for anything? Operations at all? Then usually some specific prompts based on presentation/environment...Heart problems? Lungs? Kidneys? etc.

Four parts of a medical examination are:

History

History

History

Detailed physical examination.

This is where medical examination differs from trauma assessment. Usually, one can tell what has happened from the incident (of MOI should be explored) but one usually can easily see what incident caused the trauma.

R/r 911

+1. 95% of my patients are diagnosed on hx.

 

[Brandon O]

There is the old trick where patients deny medical problems because the issues have been 'fixed'. "Do you have hypertension?" "Nope." "Why are you on this antihypertensive?". "Oh, I used to have high blood pressure, but its better now doctor has me on those pills". So the way you phrase your questions here can be important. Ask the same kind of question in 10 different ways. Any medical problems at all? Medical hx? Have you had any health problems in the past 10 years? See a doctor about anything? Been in hospital for anything? Operations at all? Then usually some specific prompts based on presentation/environment...Heart problems? Lungs? Kidneys? etc.

A good default is "has anybody ever told you that you have [high blood pressure or whatever]?" It's both temporally open and leaves room for the "wtf is that?" response when you accidentally use something jargony. "SLE?" "Yeah, you know... lupus."