Focused History and Physical Examination

What is the purpose of a focused history in a patient's diagnosis?

What is an important aspect of taking a patient's family history?

What should a physician do when conducting a review of systems?

What is the purpose of asking about the patient's social history?

What is the main focus of a focused history?

What percentage of diagnoses can be reached by combining history and physical examination?

What is the recommended action if the patient's depression worsens?

What happens to clinical reasoning as you gain experience?

What should you do if you're confident about the diagnosis?

What should you discuss with the patient in terms of the plan?

What should you do before saying goodbye to the patient?

Why is it essential to discuss diagnostic possibilities with the patient?

What is the purpose of asking if the patient has questions?

Focused History

Review HPI and Approach to… lectures
Ask questions that help you “rule in” or “rule out” diagnoses
Ask about associated factors, such as hospitalizations/ER visits, medications, allergies, and surgeries
Review Past Medical History (“SMASH”) and Social History
Focus on key aspects of the patient's history, such as significant medical problems, family history, and lifestyle habits

Focused Physical Exam

Not a full MSK exam, but a focused exam on the specific joint or area of concern
Inspect, palpate, motion test, and strength test, and then do “special tests”
Compare to the unaffected joint or area
Don't forget to incorporate osteopathic assessment into your physical exam

Assessment

What you think or know is wrong with the patient
Can be a working diagnosis, problem list, reason for visit, or differential diagnosis
90% of the time, diagnosis can be reached by history plus physical
Be specific if you're sure, and less specific if you're less sure

Diagnostic and Treatment Plan

Confirm the diagnosis or rule out a “can’t miss” diagnosis
Identify what information you need to know that you don't already have
Develop a plan to address the patient's concerns and needs
Discuss diagnostic possibilities with the patient and explain in layman's terms

Clinical Reasoning

Three types of reasoning: pattern recognition, development of schemas, and application of relevant basic and clinical science
As you gain experience, clinical reasoning begins at the outset of the patient encounter, not at the end

A comprehensive quiz on taking a focused history and physical examination, covering aspects such as acute or gradual onset, worsening symptoms, and associated conditions. Review HPI and approach to lectures.