Twenty Questions: The Value of a Good Patient History

1. Twenty Questions:The Value of a Good Patient History Presence Regional EMS System

2. Note: An additional document titled “June 2013 CE script” has been provided for use with this presentation.

3. Objectives • Discuss the value of obtaining a good patient history • Describe techniques EMS providers use to establish rapport and encourage good communications. • Review the use of SAMPLE and OPQRST in obtaining patient information • Discuss the use of critical thinking to formulate questions to explore associated symptoms and pertinent negatives.

4. Objectives • Describe pertinent questions to explore patient complaints for various body systems • Discuss some special challenges to obtaining a good patient history • Using a variety of scenarios, demonstrate how to obtain a good patient history in 20 questions

5. History • Part of the patient assessment • Concurrent • Ongoing

6. A good history is what the good EMS provider bases patient care and treatment plans on.

7. How questions are asked determines how much information a patient can and will give the examiner.

8. Warning ! • The danger lies in not getting the whole picture of what is happening with the patient. • Partial information can lead the EMS Provider in the wrong direction.

9. Patient History • Focal point of patient interaction • Active listening • Determine pertinent signs and symptoms • Rule out differential diagnosis

10. Patient Rapport

11. Rapport • Mutual understanding • Includes • Empathy • Earned trust • Encouragement to talk

12. Quiet Location

13. The First Impression • Present yourself as a caring, competent, and confident health care professional.

14. Role Models

15. Interviewing Techniques • Present yourself at eye level • Position yourself lower than the patient • Give the patient your full attention • Requests and concerns are given priority • Calm reassuring voice and demeanor

16. REMEMBER • The patient is an amateur. • Not accustomed to the process. .

17. When you introduce yourself to the patient

18. Introduce yourself • Tell them who you are • Tell them what you intend to do • Keep out of personal space until you have to • Determine what they want to be called and use that name

19. Asking Questions • Use a combination of open-ended and close-ended questions. • Make use of multiple choice for difficult concepts

20. One interviewer at a time!!! • Make sure your actions match your words!!!

21. Language and Communication • Use appropriate language. • Use an appropriate level of questioning, but do not appear condescending. • When encountering communication barriers, try to enlist someone to help. • Actively listen.

22. If you ask the right questions the patient will tell you exactly what is wrong.

24. The Comprehensive Patient History

25. Elements of the Patient History

26. Patient History • Chief complaint • Present illness • Past history • Review of systems • Pertinent negatives • Associated symptoms

27. The Chief Complaint • This is the pain, discomfort, dysfunction that caused the patient to request help. • How can I help you today? • What can I do for you today? • Never, why did you call? (sounds like an accusation)

28. Chief Complaint • When did the chief complaint begin • Have you had this before • If you have had it before, is this episode different • How did the chief complaint begin • Rapid onset • Gradual onset

30. Build Upon SAMPLE • Signs and symptoms • Allergies • Medications • Past Medical History • Last Meal • Events

31. Signs and Symptoms • Data gathered during assessment • Ask about symptoms that should be there with this complaint and are not mentioned by the patient.

32. Allergies • Medications • Foods • Environmental

33. Medications • Current prescribed medications • Over the counter medications • Herbal remedies

34. You should take your patient’s medications with you to the hospital, when practical.

35. Past Medical History

36. Current State of Health • Do you consider yourself in good health?

37. Last Oral Intake

38. Events • What were you doing when this happened? • How did this happen?

39. Onset of the problem Provocative/ Palliative factors Quality Region/Radiation Severity Time The Present Illness

40. Onset • The O stands for onset. • How did this problem begin? • Was it sudden or gradual? • What was the patient doing when the problem began?

41. Provocative/ Palliative Factors • Two parts; provocation and palliative. • What makes the problem worse (provocation) • What makes it better (palliative).

42. Quality • How does the patient perceives the symptom? • What can the patient relate the symptom to or how can it be described? • Use the word “it is like” describe quality • In the case of pain, it can be • Stabbing • Sharp • Dull • Heavy.

43. Region/Radiation • Located in one area • Move around (radiate) • Sharp vs diffuse

44. Severity • Explain clearly • Scale of 0-10 • 0 is no pain • 10 is worse pain imaginable

45. Time • What time did the problem begin? • Has the symptom been constant since that time or intermittent?

46. Associated Symptoms • Symptoms that go together to differentiate between similar complaints

47. Pneumonia Pain on inspiration Fever cough Cardiac Pain Aggravated by activity Radiating down left arm Nausea Associated Symptoms– Chest Pain

48. Pertinent Negatives • Symptoms that you expect to find, but are absent. • Reports vomiting blood but • No abdominal pain • No nausea • No dark red or brown discoloration in the mouth

49. Follow Up On Scars • When a significant scar is found on exam ask • What caused the scar? • If there was surgery was any organ removed? • How long ago was the original incident that caused the scar?

50. Review of Systems • A system-by-system series of questions designed to identify problems your patient has not already identified.