What are 10 good medical questions to ask a patient?
“Listen to your patient, he is telling you the diagnosis”. Dr William Osler (1849-1919)
.. and 80% of the diagnosis is in the medical history. Full stop.
The history is vital. Why? 80% of the diagnosis is in the history (10% examination, 10% tests) – so its your key diagnostic weapon. Also, as the placebo effect (convincing the patient that they will get better) is 50% of your healing power (and that comes from the history) you are foolish not to maximise the placebo.
How to ask them is also hard, as is how to listen to and assimilate the response.
These questions can be used in a clinical or examination setting. In both situations, speed may be of the essence, hence the need for the ability to take a history carefully but quickly.
Pre-introduction observation (before questions)
Before you start, stop, slow down and think. Just for 15 seconds.
Right. Antennae up. Observe the patient and environs around the patient. Why?
Observation is 90% of medicine”
What can you see? What’s their biological age? Walking pace? How are they dressed? What are they reading and why? Are they in pain? What’s their mood?
Wash hands. Now you can ask questions. Clock on. Here we go. What are 10 good medical questions to ask a patient? These are 10 questions you can ask in 10 minutes.
Quick medical history taking
These are ten questions you can ask, and the words to use. They can be asked in ten minutes, with the time allowances indicated below.
1. Introduction – Start with a handshake. “Hello, my name is XX and I’m a student doctor YY. You are Mr/Mrs ZZ and you are AA years old. Is that correct?” (30 sec). You can ask date of birth but that takes longer and you have to do mental arithmetic to calculate the age. The handshake is also a diagnostic tool.
2. PC – “What is the current problem” (1 min). Listen very (very) carefully. The diagnosis is often in the patient’s first few words. Write it down. Come back to that at the end.
3. HPC – “Please describe the problem in more detail, is it linked to anything, and what makes it better or worse?” (2 mins). Ditto.
To save time, ask relevant questions from systems review here (30 sec). There may not be any. You will not have time to do a full systems review.
4. PSH – “What major operations have you had?” (30 sec)
5. PMH – “Have you ever had .. diabetes, jaundice, anaemia, tuberculosis, heart attacks, strokes, high blood pressure, epilepsy, rheumatic fever, or ulcers in your tummy?” (30 sec)
Vague questions like “what other medical conditions do you have?”, or “are you under the doctor for anything?” are not helpful.
You need to have finished PMH by 5 mins
6. Drugs/Allergies – “Please show me a list of your current medication. And have you had a major allergic reaction to any medication?” (1 min)
7. SH – “Who do you live with, are you married, how many children have you had, and what is/was your current/last job?” (30 sec)
8. SH – “Have you ever smoked, and have you ever been a regular heavy drinker?” (30 sec)
9. FH – (depending on age of patient)
- “Are your parents alive fit and well?” OR
- “Are your parents still with us?” Depending on answer, “what did they die of?” OR
- “What did your parents die of?” AND
- “Are there any funny or rare diseases that run in the family?” (1 min)
You need to have finished SH/FH by 8 mins, to give time for ..
10. ICE – “What are your ideas about what’s going on, and what are your concerns and expectations (of us)?” (2 min). This also gives time for you to think what have you forgotten .. did you ask about medication/allergies and/or smoking/alcohol?
Clock off. Phew! Not quite finished.
Before you go, remember to thank them: “Thankyou very much”
Notes
- Listening is more important than talking. Asking shorter clearer questions is better than longer rambling ones – followed by active listening
- The rate of onset of a problem is very important. Things can come on suddenly (in an instant), rapidly or slowly. E.g. chest pain could be due to a pneumothorax or dissection (if sudden), MI or PE (rapid) and musculoskeletal or thoracic prolapse disc (slowly)
- Duration is important as well. Different types of illness have very different time spans
- The site of a problem is also important. Use your knowledge of anatomy, to think ‘what is there, or under there?’ Pocket Tutor Surface Anatomy (2019) is a very good book that will help you.
- Pain should be expressed on a scale of 1-10 – where 1 is a mild headache, and 10 is the worst pain you have ever had (e.g. child birth or major fracture).
- If the patient does not understand the question – rephrase it, perhaps in simpler language.
10 questions can be asked in 10 minutes
How to present that quick medical history – i.e. finish the job
The job is not done until you present the history and act on it. After all there is no point if there is no result – i.e. action from it (even if that is little action such as observation). That becomes the contract between you and the patient.
Presenting is a skill too, as important as actually taking the history. We recommend a ‘5 sentence summary method’. This is an example:
- Intro/PC. “Mr X is a 47 year old astronaut who presents with a 6 hour history of a rapid onset of chest pain” (pause, 1000, 2000 in your head)
- HPC. “He has been getting exertional chest pain for 6 weeks, getting more frequent” (pause etc)
- PSH/PMH. “He has Type 2 diabetes, but there is no other history” (pause)
- SH/FH (if relevant, or leave out). “He is an ex-smoker” (pause)
- Diagnosis (or differential if you are not sure). “The most likely diagnosis is an acute coronary syndrome, or possibly a PE” (pause, do not move on to investigations or management, unless asked. Wait for next question).
Diagnosis – syndrome vs tissue
A doctor needs to come to a specific pathological diagnosis, and conclude by asking yourself ‘what is the tissue diagnosis?’. These are not diagnoses: CKD, AKI, ACS, anaemia, low back pain etc. They are syndromes, and syndromal diagnoses.
This is a (tissue) diagnosis: “Pre-renal AKI due to hypovolaemia (‘dry’) and sepsis, which is presumed due to a R lower lobe pneumonia which is probably caused by S pneumoniae. I do not recommend a renal biopsy which would show either normal kidney or possibly acute tubular necrosis.” Talk like a doctor.
Summary
We have described what are 10 good medical questions to ask a patient. These can be asked in 10 minutes. We hope it helps you carry out histories, especially when you are under time pressure. The best way of getting good at it is practice, practice, practice.
[Oh yes. It gets easier after the first 1000. “Thanks!” MyHSN Ed.]
Other resource
These are some tips from a good Australian website called ‘Almostadoctor’.
