How Do I Sign Iowa Banking Medical History

E sign short medical history

hey guys welcome back to the channel if you're new here my name is Aaron I'm a junior doctor training in ophthalmology in London and graduates from Temple University two years ago and on the side about some medical education content onto YouTube Instagram and Twitter so go put me on there links to all the socials are in the video description so a couple of weeks ago I be do on the retrospective approach to preparing for medical school las diez and since then I've had loads and loads of requests to make a similar video on history-taking okay so I'm joking actually the only one person asked this video but hopefully a few of you find it useful in this video we'll look at the four parts that make up a good history we'll put this all into one neat structure that you can follow and then we'll look at how you can present your history findings in a clear and concise manner as usually where everything we types up below in the description and the pin comment so feel free to jump to any particular part so let's jump straight into it okay so when you're taking history whether it's from patient on the ward or whether it's an actor in your exam I think you can break down the whole process into four key parts number one information gathering and what I mean by that is getting all the relevant clinical information so your presenter can play the history of presenting complain and we all background to your part better pastry etc number two the patient's perspective so this is our ice while the patient's ideas concerns and expectations number three trying to provide a clear structure to history while including all the relevant things like starting with an open question and then moving on to more close questioning screening for either symptoms signposting gathering your eye so your ideas concerned expectations picking up on any cues from the patient summarizing as well as your systems review and number four being able to take this eight-minute history and condense it into one minute where you can present it to your examiner or jewel consultant and working out what's relevant and what's not relevant now let's try and put all of these four things together okay so during med school I was taught to take history using the Calgary Cambridge model I think a lot of medical schools use it and I think it's a very nice easy to work with method of getting all the information in a clear concise manner and I think there lots of variants and they all do the same job so the breed outside your history station will be something like this you are finding a medical student on the ward and you've been asked to take a history from mr. Jones who has come in with some chest pain you've got seven minutes to take the history and then you'll be asked to present your history to your examiner so let's have a walk through the structure to take in your medical history and we'll base it loosely around this chest pain mystery so you want to start with step 1 which is initiate the session and build rapport so we start off by introducing ourselves and confirming we have the correct patient so hi there my name is Harry Carey oh and one of the final year makeable students is it mr. Jones I understand you've come in with some chest pain I've asked some pain relievers on its way offering pain killers is just a nice way to start building that rapport with your patient step 2 screening for symptoms so the aim here is to work out what are the key problems that this patient is presenting with and there's usually two or three so here we already know one of them is chest pain before we dive into chest pain we just want to be aware is there anything else so I know you've mentioned some chest pain apart from the chest pain is there anything else that's brought you in okay that's great there's chest pain and fever anything else okay now on to step three gathering information by this point we've identified that one or two key problems that this patient is presented with and we want to tackle these individually and where we do this is we start with an open-ended question so something like tell me a bit more about the chest pain once you've asked that it's really key to just let the patient speak and let them give you as much of the information as possible then you can go into more clothes and focus questions and it's known as mnemonics that are really helpful for these clothes and focus questions so for example Socrates is used for any type of pain whether it's chest pain tummy pain or headache s4 sight so where is the pain onset so did the pain come on gradually or suddenly see for character so is it a dull pain a sharp pain a burning pain are for radiation so does the pain move anywhere a for any associated features T four times or how long does the pain last four be four exacerbating and really factors so does anything make the pain worse does anything make the pain better and finally s4 severity and usual week scale this so on a scale of one to ten with ten being the worst pain how would you rate this pain and then we use exactly the same approach but any of the other symptoms that we found from our screening so an open question and then mourn to closed focus questions now under step four which is summarized by this point you've covered most of the patients positive symptoms in detail and now you want to summarize back to them so this is where you're checking that you've understood them correctly and you want to show your examiner you're summarizing so literally use the word summarize so just to summarize what we've covered so far you've had two days of sharp central chest pain six out of ten that comes on when you take a big breath in and it seems to get worse when you're lying down and a little bit better when you're sitting forward have I missed anything so now under Step five which is risk factors this part of history is a little bit unconventional but I've decided to put it in as I kept missing out these really key parts of taking a good history and my two supervisors at medical school lucky and Rio who literally the best at history taken taught me everything both advise me have a separate section for this if you keep missing it out it's a very focused way to help you narrow down your differential so for example in this cardiac history there are four common themes of risk factors I'd like to ask so you could say things are sharing that with me I've got some very specific questions now to help me work out what might be causing one of this so vascular risk factor questions would be GM high blood pressure are you diabetic do you smoke though am i symptom questions would be do you have any nausea do you have any sweating do you ever feel short of breath do you feel your heart racing the VTE risk factor questions would be any calf swelling or calf pain any recent travel or being on a long-haul flight do you take the oral contraceptive pill and any previous clots in the leg and finally the infective endocarditis question is any recent dental work I think from an examiner's point of view even though that's a lot of questions in a short amount of time I think they know exactly what you're trying to do in terms of trying to narrow down your differential now in step six systems review and this involves a body system based screen but any symptoms that your patient may not have mentioned in your initial screen right at the start is different from the risk factor section which is much more focused questions to help narrow down your differential so in this particular chest pastry you want to ask all the cardio system review questions and I've linked to the system review questions based on their system in the video description so in this case your cardio system review questions would be do you ever feel short of breath yeah but who you own a heartbeat racing do you ever notice and the ankle swelling have you notice any leg pain on walking and have you ever felt dizzy or lost consciousness something I always add in the system review section is to ask for constitutional symptoms these are symptoms that can affect any body system and they're very easily forgotten and these include have you had any fever and your recent weight loss any tiredness and any loss of appetite so now under step 7 which is the patient's perspective and picking up on cues so even though I put this as a separate section a really good history is where this particular part is dynamic and involves three parts one of the patient's ideas concerns expectations for your eyes so you'd say do you have any ideas what might be causing one of this is anything in particular you're worried about and what you most hoping for from the doctors today I think the best time to address the patient's perspective is really defined by the cues that you get from your patient if your patient right at the start mentions their dad having a heart attack when they were young that's when you do your eyes you don't wait for doing the screening doing your systems review so now under step eight which is a background history and this involves the background medical history so your past medical history drug history family history and social history and you really want to signpost to your examiner that you're moving on to this section now I like to ask some background questions now are you normally fit in well do you suffer from any medical problems do you take any regular medication do you have any allergies any medical problems that run in the family and then finally your social history who's at home with you are you currently working and in smoking alcohol and recreational drug use and then you thank the patient and that's the end of the history that's a run-through of how to take a medical history just to summarize or the eight parts to it step one initiate the session and build rapport step two screening for symptoms step three gathering the information so that's open question listening and more close focus questioning like Socrates step towards your summarize step 5 our risks back to focus questions step 6 is your systems review and constitutional symptoms step 7 is your patients perspective and your eyes and finally step eight is your background medical history so now we've done that let's have a look at how we would present istream no one ever really teaches us how to present history but a fairly generic format is to start with the patient's name their age and their occupation then you start with your main presenting complaint with all the relevant information from your open and close questioning then any other symptoms that you've got from your screening in the patient's perspective so that ice then any relevant negative findings which you would have got from your risks back to focus questions where you try to narrow down your differential and then finally finished with your top differential so for example in this particular case of a chest pain of Street I'd the pleasure of meeting mr. Jones who was a 64 year old gentleman who's a retired teacher he presents with a 2-day history of sharp central chest pain 6 out of 10 which is pleuritic in nature and seems to get worse swings lying down and relieved on sitting forward also of note is a one-week history of constitutional symptoms including a high fever and fatigue he seems to be most worried that this could be a heart attack as his dad had heart problems when he was very young my relevant negative bindings are reassure me there's no vascular risk factors for example he's not a smoker and it's not diabetic there's no VTE risk factors and there's no history of syncope my top differential here would be acute pericarditis other differentials of this chest pain would include cardiac causes such as acute coronary syndrome respiratory causes such as pulmonary embolus abdominal causes such as gastroenteritis and finally must go skeet of causes such as muscular to a chest pain and that's just one way to try and present your history in a clear concise manner ok so that brings us to the end of this video that was just an overview of how to take a medical history I hope you found it useful if you did please give this video a thumbs up and consider subscribing to the channel I mean the process of putting all my medical school notes onto my website and that should be in the next few weeks but for now thanks for watching guys have a good night and I'll see you in the next video