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logo1 Medical Student Survival Skills

History Taking and Communication Skills

Philip Jevon RN BSc(Hons) PGCE

Academy Manager/Tutor
Walsall Teaching Academy, Manor Hospital, Walsall, UK

Steve Odogwu FRCS

Consultant General Surgery, Senior Academy Tutor
Walsall Teaching Academy, Manor Hospital, Walsall, UK

Consulting Editors

Jonathan Pepper BMedSci BM BS FRCOG MD FAcadMEd

Consultant Obstetrics and Gynaecology, Head of Academy
Walsall Healthcare NHS Trust, Manor Hospital, Walsall, UK

Jamie Coleman MBChB MD MA(Med Ed) FRCP FBPhS

Professor in Clinical Pharmacology and Medical Education / MBChB Deputy Programme Director
School of Medicine, University of Birmingham, Birmingham, UK




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This edition first published 2020
© 2020 by John Wiley & Sons Ltd

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Library of Congress Cataloging‐in‐Publication Data

Names: Jevon, Philip, author. | Odogwu, Steve, author.
Title: Medical student survival skills. History taking and communication skills / Philip Jevon, Steve Odogwu.
Other titles: History taking and communication skills
Description: Hoboken, NJ : Wiley‐Blackwell, 2020. | Includes index. |
Identifiers: LCCN 2018060341 (print) | LCCN 2018060741 (ebook) | ISBN 9781118862704  (Adobe PDF) | ISBN 9781118862698 (ePub) | ISBN 9781118862681 (pbk.)
Subjects: | MESH: Medical History Taking–methods | Professional‐Patient Relations | Handbook
Classification: LCC R118 (ebook) | LCC R118 (print) | NLM WB 39 | DDC 610.1/4–dc23
LC record available at https://lccn.loc.gov/2018060341

Cover Design: Wiley
Cover Image: © WonderfulPixel/Shutterstock

logo1 Acknowledgements

We are very grateful for the following doctors, most of who were based at the Manor Hospital in Walsall, for their help with the manuscript.

Part 1: History Taking
Abdominal distention Dr. Prashant Patel
Abdominal pain in pregnancy Dr. Chloe Ross
Abdominal pain Dr. Michael ding
Alcohol intake Dr. Manisha Choudhary
Amenorrhoea Dr. Beth‐Anne Garman
Anxiety Dr. Tracy Hancox
Ataxia Dr. Nevan Meghani
Back pain Dr. Salina Ali
Chest pain Dr. Sanam Anwari
Collapse and loss of conciousness Dr. Amar Lally
Confusion Dr. Nicola Lowe
Constipation Dr. Jess Chang
Cough Dr. Knapp Claire
Deliberate self‐harm Dr. Nicola Lowe
Diarrhoea Dr. S Mensforth & C McMahon
Dizziness and vertigo Dr. Halimah Alazzani
Dyspepsia Dr. Halimah Alazzani
Dysphagia Dr. Imad Adwan
Dysphasia Dr. Halimah Alazzani
Dysuria Dr. Manisha Choudhary
Otalgia – ear ache Dr. Karan Jolly
Falls Dr. Sarah Mensforth
Fever Dr. Beth‐Anne Garman
Haematemesis Dr. Imad Adwan
Haematuria Dr. Dominic Williams & Dr. Seshagiri Thirukkatigavoor
Haemoptysis Dr. Sanam Anwari
Headache Dr. Amar Lally
Hoarseness Dr. Karan Jolly
Jaundice Dr. Jennifer Hardy
Joint pain Dr. Jon Catley
Acute leg pain (ischaemic leg) Dr. Ayaz Vanta
Leg ulcer Dr. Oliver Oxenham
Loin pain Dr. Mohammed Jamil Aslam
Loss of memory Dr. Amy Burlingham
Low mood Dr. Tracy Hancox
Lumps and bumps Dr. Salman Waqar
Melaena Dr. Jess Chang
Menorrhagia Dr. Tracy Hancox
Nausea Dr. Sameer Patel
Numbness and weakness Dr. Halimah Alazzani
Paediatrics: Diarrhoea Dr. Chloe Ross
Paediatrics: Convulsions/seizures Dr. Chloe Ross
Paediatrics: Difficulty in breathing Dr. Chloe Ross
Paediatrics: Non‐specific unwell neonate Dr. Chloe Ross
Paediatrics: Vomiting Dr. Chloe Ross
Paediatrics: Wheeze Dr. Chloe Ross
Pain Dr. Jennifer Hardy & Dr. Katie Ramm
Palpitations Dr. Sameer Patel
Paresthesia Dr. Nevan Meghani
Per rectum bleeding Dr. Jess Chang
Preoperative assessment Dr. Gagandeep Panesar
Per vaginum bleeding in pregnancy Dr. Tracy Hancox
Pruritus Dr. Seow Li‐Fay
Pervaginal bleed Dr. Emily Tabb
Pervaginal discharge Dr. Chloe Ross
Rash Dr. Seow Li‐Fay
Red eye – Painless Dr. Rohit Jolly
Red eye – Painful Dr. Rohit Jolly
Seizure Dr. Amit Rajput
Sexual history from a female patient Dr. Sarah Mensforth
Sexual history from a male patient Dr. Sarah Mensforth
Shortness of breath Dr. Sana Qureshi & Dr. Sing Yang Sim
Stridor Dr. Emily Tabb
Substance misuse Dr. Amy Burlingham
Swollen legs and ankles Dr. Richard Screen
Syncope Dr. Amit Rajput
Tiredness/lethargy Dr. Sameer Patel
Tremor Dr. Halimah Alazzani
Unilateral leg swelling Dr. Jennifer Hardy
Varicose veins Dr. Sing Yang Sim
Vomiting Dr. Knapp Claire
Weight gain Dr. Richard Screen
Weight loss Dr. Jennifer Hardy
Wheeze Dr. Jennifer Hardy
Part 2: Communication Skills
The angry patient Dr. Jennifer Hardy & Dr. Katie Ramm
Breaking bad news or results Dr. Anne de Bray
The deaf patient Dr. Jennifer Hardy & Katie Ramm
Diabetes counselling Dr. Anne de Bray
Explaining a clinical procedure Dr. Gagandeep Panesar
Insulin counselling Dr. Anne de Bray
Life style advice post myocardial infarction Dr. Dhruti Pandya
Cessation of smoking Dr. Sanghera Parmjit
Oral steroids counselling Dr. Jaspreet K Saggu

About the companion website

flastf01 www.wiley.com/go/jevon/medicalstudent

Part 1
History Taking

1
Abdominal distention

Differentials

  • Common (important causes): ascites, bowel obstruction (from cancer, adhesions, sigmoid volvulus, hernia, etc.), diverticulitis, coeliac disease, inflammatory bowel disease (IBD), constipation, medications

History

History of presenting complaint

  • Open question assessing duration of abdominal distention
  • Onset, triggers, how long for
  • When was the last time they opened their bowels/passed wind. If they can open their bowels, does this relieve the distention?
  • Any per rectum (PR) bleeding
  • Any vomiting/nausea
  • Abdominal pain: use SOCRATES template (see Chapter 8)
  • Any weight loss
  • Any change in appetite
  • Any shortness of breath
  • Previous abdominal distention
  • Any signs of jaundice – pale stools, dark urine, itching
  • Urine symptoms: dysuria/frequency/dribbling/hesitation, etc.

Past medical and surgical history

  • Constipation, diarrhoea, change in bowel habit. Any IBD?
  • Any previous surgery, especially gynaecological/abdominal
  • Any previous medical history
  • Use MJ THREADS (Box 1.1)

Medications and allergies

  • Current medications
  • Allergies

Family history

  • Any family members with similar symptoms
  • Any family history of malignancy
  • Any illnesses that run in the family

Social history

  • Who patient lives with
  • Occupation (e.g. healthcare setting)
  • Smoking and alcohol
  • Recent foreign travel

Investigations

  • Bloods: full blood count (FBC), urea and electrolytes (U&Es), C‐reactive protein (CRP), amylase, clotting, albumin, international normalised ratio (INR)
  • Imaging:
    • Erect chest X‐ray – perforation/pleural effusion
    • Abdominal X‐ray – bowel obstruction/toxic megacolon (for ulcerative colitis)
    • Computed tomograpy (CT) of the abdomen – to further investigate the cause of, for example, bowel obstruction/ascites
  • Diagnostic/therapeutic: ascitic tap if presence of ascites – transudate or exudate

2
Abdominal pain in pregnancy

Differentials

  • Common: urinary tract infection (UTI), constipation, symphysis pubis dysfunction, ligament stretching, labour, placental abruption, pre‐eclampsia, surgical causes (including appendicitis and cholecystitis), pyelonephritis, ovarian cyst torsion/rupture, uterine fibroid torsion or red degeneration
  • Rare: uterine rupture, uterine torsion, rectus sheath haematoma, acute fatty liver of pregnancy

History

History of presenting complaint

  • What is the abdominal pain like – use the SOCRATES approach (see Chapter 8)
  • Any per vaginum (PV) bleeding? If so quantify amount, number of episodes and type of blood
  • Are they feeling the baby move ok?
  • Any change in discharge or episode of watery discharge
  • Any nausea or vomiting
  • Any dysuria or frequency or retention
  • Are the bowels open normally; any constipation or diarrhoea
  • Any headache or blurred vision
  • Any swelling
  • Any fevers
  • Any jaundice
  • When was the last time they had fluid and/or food (in case they need to go to theatre)?

Past medical and surgical history

  • Obstetric history
    • Current gestation
    • Number of previous pregnancies including miscarriages, terminations, and still births and gestations and types of these (e.g. medical or surgical termination, was it a missed miscarriage and required medical or surgical treatment?)
    • Number of live births – gestation, mode of delivery, any problems during pregnancy, with the labour or with the child
    • For this pregnancy – any problems so far, any problems on scans, any hospital admissions
  • Any medical conditions – any known fibroids, ovarian cysts, congenital uterine abnormalities
  • Any operations – particularly gynaecological or abdominal

Medications and allergies

  • Any regular medications, any recent medications
  • Any allergies

Family history

  • Any family history of pre‐eclampsia

Social history

  • Who lives at home
  • Occupation
  • Smoking – number per day and for how many years
  • Alcohol – number of units per week

3
Abdominal pain

Differentials

  • Common: urinary tract infections (UTIs), appendicitis, gastroenteritis (viral, bacterial, and parasitic), ulcers, inflammatory bowel disease (IBD), constipation, gallstones, cholecystitis, pancreatitis, pelvic inflammatory disease, kidney stones, bowel cancer, irritable bowel syndrome (IBS), mesenteric adenitis, diverticulitis
  • Rare: coeliac disease, lymphoma, abdominal aortic aneurysm (important not to miss), ectopic pregnancy, Henoch–Schonlein purpura, intussusception

History

History of presenting complaint

  • Site
  • Onset
  • Character
  • Radiation
  • Associations – with food (biliary colic)
  • Time course
  • Exacerbating/relieving factors
  • Severity
  • Nausea/vomiting
  • Dysphagia
  • Bowels – regular, diarrhoea, constipation, bloatedness, altered bowel habit, hard to flush, tenesmus
  • Malaena/rectal bleeding
  • Any weight loss, fever, anorexia, lethargy, or early satiety
  • Jaundice
  • Menstrual history – last menstrual period, regularity, contraception, pregnancy, amenorrhoea, dyspareunia, post‐coital bleeding or PV bleeding/discharge
  • Urinary‐dysuria, frequency, hesitancy, post‐micturition dribbling, haematuria, history of recurrent UTIs,

Past medical and surgical history

  • Previous abdominal pains
  • Constipation, diarrhoea, IBS, IBD
  • Any other illnesses
  • Any previous surgery – especially gynaecological or abdominal

Medications and allergies

  • Current medications, laxative use, recent antibiotics
  • Allergies

Family history

  • Any family members with similar symptoms
  • Any illnesses which run in the family, coeliac disease, IBS, IBD, malignancies

Social history

  • Who patient lives with
  • Occupation (e.g. healthcare setting)
  • Smoking and alcohol
  • Recent foreign travel

4
Alcohol intake

History

History of presenting complaint

  • Alcohol intake
  • Frequency of consumption
  • Units consumed per day/per week/per session (if binging)
  • Adequate dietary intake
  • CAGE (screening method):
    • Cut down on drinking
    • Annoyed by criticism of drinking
    • Guilty about drinking
    • Eye opener
  • Evidence of withdrawal:
    • Tremor, confusion
    • Seizures, hallucinations (delirium tremens)
  • Previous rehabilitation or alcohol cessation

Past medical history

  • Mental health disorders
  • Liver cirrhosis, hypertension, cardiac arrhythmias
  • Gastric/peptic ulcers, varices, pancreatitis

Medications and allergies

  • Current medications
  • Allergies

Social history

  • Who patient lives with, housing
  • Smoking, illicit drug use
  • Support network
  • Social services involvement