Tiêu đề Excellence Skill (History, Com skill, Procedure).pdf ✅

Excellence for MRCS OSCE By Dr. Rifat & Dr. Hasnat 2 HISTORY TAKING FORMAT BASIC PRINCIPLES OF HISTORY TAKING « Open questions: What’s the problem? (Listen) « Closed questions: What does patient wants to say in favor of main differential? (Clarify) « Focused questions: Exclude Differentials (Narrow) « Fixed questions: By answering Yes or No (Fitness, comorbidities & relevant) BASIC STEPS OF HISTORY TAKING 1. Introduce yourself (Your name, position, your consultant’s name if present) « Hello, good morning/evening, I’m Dr..........., « One of the surgical doctors here/ one of your attending doctors today « Working for Dr......... 2. Confirm patient’s ID and obtain verbal consent « May I confirm your name and age please? « Nice to meet you Mr/Ms........... « Today I’m here to ask you some questions regarding your condition, that may help us for your diagnosis. Are you okay with that? /Does it sound good? / Can we proceed? 3. Main history « How can I help you? « What brings you here today? « Can you please tell me why you are here today? « Can you describe your difficulty in your own words for me? SOCRATES formula for pain, ODIPARA for other conditions SOCRATES for pain « Site - Where do you feel the pain? Could you locate the pain for me? « Onset & duration - When did it start? How did it start? « Character - Could you please describe the pain for me (Is it crushing/ cramping/ colicky/ stabbing)? « Radiation – Does your pain go/move anywhere else? « Associated factors – reserved to exclude differentials. « Timing - Is there any specific time during the day that the pain increases? « Exacerbating & relieving factors – Is there anything that increases or decreases your difficulty? « Severity – If you had to rate your pain, from 1 to 10 with 10 being the worst pain you could ever imagine, how much would you rate it? (Verbal numerical rating score)/ How badly does it affect your day-to-day life? ODIPARA for other conditions « Onset – How did it start? « Duration – When did it start? « Intensity - How badly does it affect your day-to-day life?/ How frequently does it occur?/ Any other relevant questions (e.g., High/low grade fever) « Progressiveness – Is it progressively worsening day by day? « Aggravating factors – Is there anything that increased your difficulty? « Relieving factors – Is there anything that decreases your difficulty? « Associated features – Exclude differentials.
Excellence for MRCS OSCE By Dr. Rifat & Dr. Hasnat 3 4. Exclude differentials « Ask 1/2 questions to exclude each differential. (Maximum 3-5) 5. 5 important questions « Past medical history - Do you have any other medical conditions (like asthma, COPD, TB, DM, HTN) for which you seek your GP? « Past surgical history- Have you undergone any surgeries before? « Medication history – Do you take any medications regularly? If yes, then ask for dose and duration. « Allergic history – Do you have any allergies to any medications or foods? « Bladder and bowel habit – What's about your peeing (not in urological cases) and pooing (not in diarrhoea or constipation if patient already mention in main history) habit? Is there anything wrong? « Immunization history (if you have time)– Have you completed your immunization in childhood? 6. 5 personal questions (seek permission again) « Occupation history - What do you do for living? « Marital status - Whom do you live with? « Family history - Can you remember if any of your family members had similar conditions? « Smoking history – Do you take cigarettes? If yes, then ask for how many sticks and duration. « Alcohol history – Do you drink alcohol? If yes, then ask for unit and duration. 7. Systemic review « Ask 1-2 questions from every system and instruct the patient to answer by saying YES or NO. 8. Anything that patient may want to add - Is there anything you want to add, that i might forget to ask? 9. ICE « Idea - What’s your idea regarding your condition? / What do you think the cause might be? « Concern – What concerns you the most? « Expectation – What do you want us to do for you? 10. Thank you for your co-operation. I will consult with my consultant regarding your condition and get back to you. If you have any further queries, don’t hesitate to contact me. I will leave my bleep number at the nurse station. Have a nice day. Thank you. ***Ask for chaperon in impotence station, offer analgesia and switch off light in Headache station. *** Don’t forget to wash your hands before and after the station. PRESENTATION Mr./Mrs. X, a Y-year-old occupation, previously fit/smoker/social drinker, presented to me with the complaints of ____ for _____ days/months which is associated with (Positive points of SOCRATES/ ODIPARA). He has no history of (Exclusion criteria of 2/3 major differentials). He has a history of (Positive points of 5 important and personal history). Considering all of this, my provisional diagnosis is _____, I will also consider (differentials).