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USMLE Step 2 CS Communication Skills Step 2 CS Communication, Spoken English Proficiency, Language and Interpersonal Skills Discussion forum. CIS and SEP components of the USMLE Step 2 CS Exam.


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  #1  
Old 01-14-2013
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Smile Starting with past medical history!

Dear doctors ,

I decided to start my encounter first with some question about past medical history, past surgical past sexual and social with explaining the pt that the reason for that is to get more clues to help me to get to his problems and only AFTER i start with ".. and now i would like to address your current complain.." what is your idea about that??? any one did the same ?

i find it more useful to gather info to start from the past till the present day.

please advise.

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Old 01-14-2013
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It's not advised to start with the past medical history not only in the CS exam but also in real life. No medical school and no physician have ever advised to start with past medical history.

The patient wants to see that you are concerned about his chief complaint first, he/she will not appreciate it if you start backwards.

Likewise, the SPs, are trained to check you off on points, these points start with the chief complaint and the HPI.

Bottom line, do not do it.

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Old 01-14-2013
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Thanks, usmle world videos and text suggest to start with past medical history and than present illness... Advise?
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Old 01-14-2013
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If they did then they are wrong.

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Old 01-17-2013
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Yes I too was having similar doubt...
Usmle world the most trusted site for USMLE in the very first page of technique of history taking...telling about HPI last method and starting with past medical illness..

So what is the method all are following...Everybody is using UW...
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Old 06-12-2013
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Actually, many med schools follow this routine. Especially the French ones, and I think even the German med schools. My own med school (Romania) and much of eastern Europe, follow this pattern. Ask about past medical history, and then concentrate on HPI. They taught us in both ways, and left the asking/PN writing to the student's preference.

I remember in my internal medicine classes, our instructor taught us this way of taking history and compared it to the Western standards. He said the advantage is that if you start from HPI, the patient will tell you so many things wrong with him at the same time, you don't really know which one is the most important to address. Starting backwards gives you a sense of where he is at, and lets you connect the dots much easily to the HPI. Also, once you start backwards, you've already developed the patient-relationship. And when you finally get to the HPI, the patient will be more willing to tell you the most important problem, rather then all the problems (In reality, you just tired the crap out of him )

Many old professors are used to this routine, and they even mark you if you do it the opposite way

But anyway, on CS, its best to stick to the HPI first, and then past.
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Old 06-12-2013
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Originally Posted by Smashingdude View Post
Actually, many med schools follow this routine. Especially the French ones, and I think even the German med schools. My own med school (Romania) and much of eastern Europe, follow this pattern. Ask about past medical history, and then concentrate on HPI. They taught us in both ways, and left the asking/PN writing to the student's preference.

I remember in my internal medicine classes, our instructor taught us this way of taking history and compared it to the Western standards. He said the advantage is that if you start from HPI, the patient will tell you so many things wrong with him at the same time, you don't really know which one is the most important to address. Starting backwards gives you a sense of where he is at, and lets you connect the dots much easily to the HPI. Also, once you start backwards, you've already developed the patient-relationship. And when you finally get to the HPI, the patient will be more willing to tell you the most important problem, rather then all the problems (In reality, you just tired the crap out of him )

Many old professors are used to this routine, and they even mark you if you do it the opposite way

But anyway, on CS, its best to stick to the HPI first, and then past.
I was not aware of the fact that other countries follow this routine. Thank you for the information.
Anyway, as you mentioned, for the CS exam, it's better to stick to the US standards which is leaving past medical history to the end.

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