Taking a Good History of the Present and Past can help to steer the course of treatment. In the medical arena, an important time to steer the ship/treatment plan in the right direction is by the patient giving good historical information. Get your patients prepared with the sending them an historical review checklist when they schedule with an injury (limiting them to one or two sentences per letter). This will point you as the doctor or therapist along the right path/channel and it will help the patient get better faster. Tell the patient to think over each question carefully when answering. The process will clear the patient's head and keep them focused on the most important aspects. While many of these questions can be the most helpful clues, it may also free the doctor/therapist to ask the key specific questions related to the specific injury (for example, does your painful knee lock to where you cannot bend it?).
I would like to introduce you to a mnemonic that I used in medical school for asking a great history. The basic questions over the years have remained the same and the hallmark of great history taking. I hope the patient can take these questions and make them paint an accurate picture of their problem for the doctor/therapist. I have found one phrase from the patient can change the entire course of the treatment direction started.
The mnemonic goes like this:
F Family history of similar problem? Frequency of pain (how often)?
A What is your Assessment of the problem (what do you think it is)?
What part of your Anatomy is involved?
I How Intense (use pain scale) is the pain? What Irritates it (makes it
worse)?
L With one finger, point to the exact Location of the worst pain.
E What Eases the pain? Does the pain have an Electric sensation with it?
D What has been its Duration (how long has it been going on)?
O What were all the events surrounding the Onset of pain? Are there
any Observable skin changes?
P Pain scale (0-10) sleeping? Getting out of bed? During activity? End
of the day?
Q What is the Quality of pain (burning, tingling, dull ache, sharp,
numbness, throbbing, pulsating, etc.)?
R Is there Redness? Does the pain Radiate, and where to?
S How does Shoe gear or barefoot affect it (or high heels, or various
types of shoes)?
T What have you done to Treat the problem? What Treatment has
helped? What Treatment has made it worse?
U Are there Underlying health issues (diabetes, osteoporosis,
arthritis, poor circulation, etc.)?
V Does the pain Vary (better at different times, worse at other times)?
W Can you Work? Were you injured at Work? Does this affect your Work
shoes?
I have used this for 40 plus years in practice. Of course, sometimes I just focus on some of them when time is limited. I always love when they bring in the answers that they have them time to reflect on for some time. When a patient presents with a long version of their history, I loved to give them this and promised to go over on the 2nd visit. The first visit with the patient is too crucial to get our examinations done. And, the patients again are told to limit each letter to one or two sentences at most! Some patients are wordy, and that can get in our way of treatment.
