“Question one: mumble mumble mumble. Question two: …” Wait?! Is he reading us test questions in advance?! My junior year in college, one of my professors dedicated the final session of the semester to a review so that we could be well-prepared for the final. I quickly realized that he was holding the final exam in his hands and reading us all the questions – and then discussing the answers. Awesome! I fumbled in my backpack and switched on my tape-recorder. Having been given both the questions and answers in advance, that final was the easiest test I’ve ever taken.
I’d like to expand that approach to other areas of life. It would be so nice to have all the questions in advance, and know exactly what information is expected in the answer. This would be particularly helpful during interactions with doctors. If I know what the doctor is going to ask, I can prepare in advance and be ready to give the best possible answer.
My most recent book acquisition, The Medical Interview was made hoping to shed some light on the questions doctors ask their patients. Unfortunately, getting a list of those questions isn’t quite as simple as getting an advance-copy of a final exam. The book is more of a discussion of the different things a doctor needs to know about, along with tips for getting the required information, than it is a list of specific questions that should be asked. Nonetheless, it’s been good reading.
In general, the doctor will ask questions looking for information about:
Chief Complaint (c/c): Why are you seeking help from a doctor? It makes sense to start with a What can I do for you today? type of question. Now that I’ve finally figured out that I can type a short note clearly describing the problem (eliminating the need to tell the nurse, then repeat the exact same information for the doctor), I learn that things aren’t always that straightforward. Sometimes the doctor doesn’t just want to know what’s wrong, but also why the patient wants the problem addressed. And why now. Why not last month or next week or some other time? I don’t recall any of my doctors ever asking a why now type of question, but perhaps I’ve just been oblivious.
History of Present Illness (HPI): What are the symptoms? Where? When did the symptoms begin? Does anything make the symptoms better? Does anything make the symptoms worse? What home treatments have you tried?
Past Medical History (PMH): Has anything similar ever happened before? Do you have any allergies? Do you actually know what an allergy is? What type of reaction do you have to any supposed allergens? Are you taking any medications? Have you ever been hospitalized for anything? Any GI issues? What time do you go to sleep? What time do you get up? How would you rate the quality of your sleep? Is there a family history of similar medical issues? Do you have any other active medical issues?
Social History (SocHx): What are your living arrangements (location? house/apartment? friends/family/alone?)? What is your occupation? Former occupation? (my doctors have never asked this) What is your educational status? (my doctors have never asked this, either) Do you drink alcohol? Quantity & frequency? Do you use tobacco? Do you use recreational drugs? Are there any risk factors for domestic violence? Do you have a support system if help is needed? How would you describe your exercise routine?
Review of Systems (ROS): Questions related to various organ systems that might relate to the chief complaint – sometimes general, but can be highly modified toward the c/c.
These questions aren’t exhaustive, but provide a good general picture of the information needed. As I learn about the different questions that a doctor might ask, it emphasizes how beneficial it can be to have an ongoing relationship with a doctor. My doctor might check previous pages in my chart to look for information, but he doesn’t ask about social history and rarely asks about past medical history.
It is much easier to prepare for an appointment if I know what kinds of questions the doctor might ask.
∞ itis 
A new doctor never fails to ask my husband (with warmth and interest) what his occupation is. I’m not sure if it’s because he doesn’t look like a guy who works a desk job, or if it’s just the underlying sexism at work.
(I can’t give you a good data point for me, because I don’t have medical issues.)
Great post. The more the public knows about how the medical interview works the more efficient and effective it will become for the doctor.
Just reading this info puts you light years ahead of other patients. Because doctors have to use this formula for gathering information if you know the way and can help us follow it we will think you are the most brilliant patient we have!
Camilla…this is discussed in Dr. Groopman’s wonderful book. Doctor’s often do a silent type of emotional survey that starts with your handshake. Maybe a type of body language litmus test? I laughed one night reading about a doctor who dumps patients who give him the stink eye! I mean really…the scene is serious….but so intense and uncomfortable. If I was that upset with a doctor I would either move on, or just tell them what I do not appreciate. But the stink eye? Wow! That’s one unhappy camper, or someone who needs glasses! I thought only wives did the silent treatment, read my eyes stuff! This guy was getting it from patients then dumping them. Wonder how he handles it at home? 🙂