Podcast
Questions and Answers
During a patient history, what is the primary reason for asking "Why have you come to see me today?"
During a patient history, what is the primary reason for asking "Why have you come to see me today?"
- To evaluate the patient's understanding of medical terminology.
- To establish the patient's chief complaint and primary concerns. (correct)
- To determine if the patient has been referred by another doctor.
- To assess the patient's mood and emotional state.
Why is it crucial to specifically ask about any red flag or medical items during a patient history?
Why is it crucial to specifically ask about any red flag or medical items during a patient history?
- To create a comprehensive list of the patient's past medical appointments.
- To identify potential serious underlying conditions that may require immediate attention. (correct)
- To ensure accurate billing and coding for the visit.
- To comply with hospital regulations and guidelines.
A patient reports experiencing knee pain. What is the importance of inquiring about when the pain first started and when the current episode began?
A patient reports experiencing knee pain. What is the importance of inquiring about when the pain first started and when the current episode began?
- To determine the patient's eligibility for physical therapy.
- To assess the patient's pain tolerance level.
- To differentiate between a new injury and a chronic or recurring problem. (correct)
- To predict the time it will take to resolve the patient's problem.
During a patient interview, why is it important to ask the patient to point to the specific anatomic location of their pain or complaint?
During a patient interview, why is it important to ask the patient to point to the specific anatomic location of their pain or complaint?
When taking a patient history, why is it recommended to use the patient's own words to describe their symptoms instead of suggesting terms to them?
When taking a patient history, why is it recommended to use the patient's own words to describe their symptoms instead of suggesting terms to them?
What is the main purpose of reviewing a body chart with a patient during history taking?
What is the main purpose of reviewing a body chart with a patient during history taking?
When inquiring about how a patient's pain or symptoms began, what level of detail is necessary?
When inquiring about how a patient's pain or symptoms began, what level of detail is necessary?
During a patient history related to an overuse injury, when might determining the specific causative event be less straightforward?
During a patient history related to an overuse injury, when might determining the specific causative event be less straightforward?
When documenting a patient's pain, why is it important to assess how the pain has changed since it first began?
When documenting a patient's pain, why is it important to assess how the pain has changed since it first began?
In patient evaluation, how can you best capture both "quantity" and "quality" of a patient's pain?
In patient evaluation, how can you best capture both "quantity" and "quality" of a patient's pain?
Why is it important to ask a patient how their symptoms change over the course of a day?
Why is it important to ask a patient how their symptoms change over the course of a day?
When is it clinically relevant to ask a patient if they have ever experienced their current symptoms before?
When is it clinically relevant to ask a patient if they have ever experienced their current symptoms before?
During a patient assessment, how does asking "What makes it worse?" contribute to understanding their condition?
During a patient assessment, how does asking "What makes it worse?" contribute to understanding their condition?
What is the benefit of asking, "When you have symptom X, do you also have symptom Y?"
What is the benefit of asking, "When you have symptom X, do you also have symptom Y?"
How does the question, "How does this affect your daily function?" provide valuable insights during a patient assessment?
How does the question, "How does this affect your daily function?" provide valuable insights during a patient assessment?
Why is it important to inquire about a patient's current medications during a history?
Why is it important to inquire about a patient's current medications during a history?
How do a patient's goals for physical therapy influence the treatment plan?
How do a patient's goals for physical therapy influence the treatment plan?
In what way does understanding whether a patient has seen or plans to see a physician contribute to the overall assessment?
In what way does understanding whether a patient has seen or plans to see a physician contribute to the overall assessment?
How does providing an opportunity for the patient to share additional information aid in the history-taking process?
How does providing an opportunity for the patient to share additional information aid in the history-taking process?
Flashcards
Why are you here today?
Why are you here today?
Identifying pain/symptoms and loss of function, to better understand the patient's condition.
Red flag medical questions
Red flag medical questions
Key medical conditions that might indicate a serious underlying issue.
When did the pain start?
When did the pain start?
Pinpointing the original onset helps trace the issue's development.
Where are the pain/symptoms?
Where are the pain/symptoms?
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Review body chart
Review body chart
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How did the pain begin?
How did the pain begin?
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How has it changed?
How has it changed?
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How do you feel now?
How do you feel now?
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Changes during the day?
Changes during the day?
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Experienced this before?
Experienced this before?
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What makes it worse?
What makes it worse?
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What makes it better?
What makes it better?
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Do you have this symptom?
Do you have this symptom?
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Affects daily function?
Affects daily function?
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Taking any medications?
Taking any medications?
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Goals for physical therapy?
Goals for physical therapy?
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Study Notes
- Questions for the History: MEMORIZE
- Order for these questions can be nonspecific
Reason for Visit
- Find out why the patient is visiting
- Differentiate between pain and loss of function
Red Flags and Medical Items
- Always inquire about red flags and relevant medical information
Onset of Pain
- Determine when the pain or complaint first started
- Ascertain when the first occurrence was, especially if it was several years ago
- Identify when the current episode began
Location of Symptoms
- Pinpoint the specific anatomic location of the pain or symptoms
- Have the patient point to each area of pain or complaint
- Avoid leading the patient by using your own words, ask about the patient's symptoms using their own terminology to avoid bias.
- For example, use "heaviness in my arm" or "tingling in my foot" if the patient uses those terms
Symptom Chart Review
- Review a body chart to ensure a complete understanding of the patient's symptoms
- Use the body chart as a guide, inquire about each body region or joint within the relevant upper or lower quarter based on the location of the patient's primary complaint
- Mark where symptoms are and are not present on a blank body chart
How Pain Began
- Determine the specific mechanism of injury, if applicable
- Overuse injuries may not have a clear causative event
Changes Since Onset
- Assess how the pain/symptoms have changed since they first began
- Consider intensity, location, frequency, and irritability
Current Feeling
- Ask how the patient feels now
- Use a pain scale to quantify pain from 0-10 and assess the quality of pain in each problem area
Daily Variations
- Determine how the pain changes over the course of a day
- Determine if the pain is worse in the AM or PM
Previous Experiences
- Ask if the patient has experienced anything similar before
Aggravating Factors
- Identify what makes the pain worse
Alleviating Factors
- Identify what makes the pain better
Associated Symptoms
- Investigate if other symptoms occur with the primary symptom
- Phrase the question in reference to each aggravating factor
- Use the phrase: "When this symptom (P1) gets worse, what happens to this other symptom (P2)?"
Impact on Daily Function
- Determine how the pain affects daily function
- Ask for specific examples such as sleep disturbance, work-related activities, daily activities, recreational or leisure activities
Medication Use
- Ask if the patient is taking any medications and for what reasons
- Ask whether medications are related to general health or pain management
Goals for Physical Therapy
- Determine the patient's goals for physical therapy
Physician Consultation
- Ask if the patient has seen a physician for this issue or plans to do so
Additional Information
- Ask if there is anything else the patient wants to tell you
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