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Old 06-28-2011
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Help Asking open-ended questions in the beginning

I've come up with a technique which is as follows, but I'm not sure if would be OK.

After introduction,..etc:

Me: Can you please tell me how can I help you today?
SP: I have chest pain.
Me: I'm sorry to hear about that; I'll do what I can to help you. Can you tell me more about it?

Kaplan recommended that you ask that latter question as the patient may tell you a lot of stuff like onset, progression, location,..etc, all in one answer, but would it sound like I'm not specific enough in my question? especially after I've asked the first question.

What do you think?
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Old 06-28-2011
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Arrow I wouldn't recommend that in the beginning

Some SPs will tell you the whole story when you ask open ended questions which is a great thing and saves time and can help you get into points that you might otherwise forgotten.

However, some SPs, are not that helpful. When you ask them an open ended question they may just tell you one or two things (they want you to ask them specific questions so that they check you out in their list).

Therefore, it's safer to be more specific and ask about onset, severity, duration, radiation, associated symptoms, ....etc one by one.

You can ask the open ended question when you finish the HPI or when you wash your hands. This will likely make the SP tell you any points that you might have missed.

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Old 06-29-2011
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I think that is a good idea. I wrote the OPDF then important qns And the PAMHUGSFOSS in my blue paper. so when I ask a qn like tell me more about your chest pain, I listenned to the patient and tick or note the information I get beside the O/P/D/F thus when the SP is done I will know whAT HE DID NOT COVER AND ASK THAT
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Old 03-11-2014
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I'm also thinking about asking open ended question first, like:

How can I help you?
Can you tell me more about it? (LIQR or course)
Please tell me how it started. Onset - setting - constant? Frequency? Duration of episodes?
How did it progress until today?
Is there anything that makes it worse?
Is there anything that makes it better?
Did you have other symptoms during this illness? --> Associated, ROS
Summarize. Is there anything else you would like to add?
Proceed to past history.


Then, I'll just ask specifically what the patient missed for every open ended question.


One potential problem is that it may be hard to take note of all the info the SP will give at once. If it's really a lot, I'll just say "Please let me take note of this. It's very helpful and important (writes for a few seconds)" ---> asks specific questions.


Do you think this is a good history flow?
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Old 03-15-2014
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Quote:
Originally Posted by Sabio View Post
Some SPs will tell you the whole story when you ask open ended questions which is a great thing and saves time and can help you get into points that you might otherwise forgotten.

However, some SPs, are not that helpful. When you ask them an open ended question they may just tell you one or two things (they want you to ask them specific questions so that they check you out in their list).

Therefore, it's safer to be more specific and ask about onset, severity, duration, radiation, associated symptoms, ....etc one by one.

You can ask the open ended question when you finish the HPI or when you wash your hands. This will likely make the SP tell you any points that you might have missed.

-
This is neither safer nor best practice, robs the patient of their chance to explain their symptoms in their own way, and isn't conducive to developing a good rapport. Asking open questions at the start of the history will allow the patient to explain in their own words what their chest pain is like and how they experience it, and this information is golden. Yes some patients will need further guidance in giving important pieces of the history, but dont miss out on this opportunity and jump straight into specifics about onset, severity etc.

Always start with an open ended question, such as your example "tell me more about your chest pain" listen to what the SP has to say, and then you can cover anything else that you need with more specific questions

There shouldnt be any need to pick up bad history taking habits just because this is an exam and time is more of an issue
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