I See I Had ... Past Medical History


Study Notes:

  1. 1.Ask about the patient’s medical history.  What medical problems do they have?

  2. 2.Make up a list of medical problems (or use mine) to ask patients about if they can’t think of any medical problems they have.  It might help them remember.

  3. 3.If the patient reports a medical problem, be sure to ask if there is any more.

Past Medical History


http://www.luciqcs.com/ev/1/image/clipboard.gif  October 2008.

The first three questions we asked were: Who are you? What’s wrong? and What happened?

The next three things we ask about will tell us about the patient’s medical status.  The first thing we ask about is the patient’s medical history.  Specifically we ask if they have any past medical history (often charted as ‘PMHx’).

Don’t be surprised if they say ‘no’ and then later tell you that they take insulin or nitroglycerin.  People often get so used to their medical conditions that they stop thinking about them as ‘medical conditions’.  For that reason it’s good to memorize the following closed-ended questions (or a list like this):

  1. Bullet Do you have any problems with your: kidneys, lungs, heart, liver or brain?

  2. BulletDo you have diabetes, epilepsy, asthma or respiratory problems?

  3. BulletHave you ever had a stroke, heart attack, seizure or other problem like that?

  4. BulletHave you ever broken any bones?  Have you ever been hospitalized or had any operations (If yes, what for?)

If the patient tells you about any medical problems, it’s important to make sure you ask ‘is there anything else’?  Make sure you keep on asking that.  Don’t make the mistake of assuming that the first medical problem they tell you about is the only medical problem they have.

It is also important to know what is relevant to the current problem.  This is more difficult than it sounds, and it comes with experience, although some examples are obvious.  If you have a 75 year old male with a cardiac history, experiencing anginal chest pain, the fact that he had a torted testicle at 16 years old is irrelevant.  We don’t need to know about every sprained ankle.  When you’re a rookie, a good rule of thumb is to try to organize it by body system: if they’re having a neurological problem, have they ever had any other neurological problems?  If they’re having a kidney problem, have they ever had any other kidney problems?  And, as always, be sure to ask about problems with the big three - their brain, heart and lungs - as a bare minimum.

You gotta ... wha? ...
can you spell that?