Week 1: History Take
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What must patients be in order to provide consent?
Patient must have capacity, be informed and provide consent voluntarily
What is phase 1 of a clinical consultation?
History taking and information gathering
What is phase 2 of clinical consultation?
Examinations, physical, objective, mental findings
What is phase 3 of clinical consultation?
Explanation, information giving, decision making
What is the structure of history taking?
• presenting complaint • history of presenting complaint • past medical history • drug history • family history • social history • systematic review
What is the acronym for a history take?
Polly Has Pretty Damn Fine Sexy Socks
What acronym is used to clarify symptoms in HPC?
SOCRATES
What does SOCRATES stand for?
• site • onset • character • radiation • associations • timing • exacerbating factors • severity
What types of drugs should you ask a patient if they use?
• prescribed drugs • non prescribed drugs • recreational drugs • vitamins/ supplements
What other things should you ask in drug history?
• compliance • dose and duration • drug allergies and sensitivities
What should you ask about within the family history?
• illnesses which run in the family • parents and siblings • cause of death • diagnosis and age
What should you ask about in social history?
• family situation • relationships • occupation • support network • hobbies • carers • social service input