1. Medical History Dr.H.N.Sarker MBBS. FCPS (med). MACP(USA).
MRCP (London). MRCPS(GLASGO)
Associate professor
Medicine

2. “Patient suffers from disease but presents with symptoms”
Dr.Sarker.

3. Cardiorespiratory Chest pain Intermittent claudication Palpitation
Ankle swelling
Orthopnoea

4. Cardiorespiratory Nocturnal dyspnoea Shortness of breath
Cough with or without sputum
Haemoptysis

5. Gastrointestinal Abdominal pain Dyspepsia Dysphagia
Nausea and/or vomiting
Change in appetite

6. Gastrointestinal Weight loss or gain Bowel pattern and any change
Rectal bleeding
Jaundice

7. Genitourinary Haematuria Nocturia Frequency Dysuria
Menstrual irregularity - women
Urethral discharge - men

8. Locomotor
Joint pain
Joint swelling
Change in mobility

9. Neurological Seizures Collapse or blackouts
Dizziness and loss of balance
Vision
Hearing
Transient loss of function (vision, speech, sight)

10. Neurological Paraesthesiae Weakness Wasting
Spasms and involuntary movements
Pain in limbs and back
Headache

11. Traditional history-taking model
Presenting complaint
History of presenting complaint
Past medical history
Drug history-Allergy history
Family history
Social history
Systems review

12. The Calgary-Cambridge framework

13. Initiating the session
Begin by greeting the patient and obtaining their name.
Introduce yourself, your role, and the nature of the interview.
If appropriate, obtain verbal consent for the interview.

14. Communication skills in the medical interview
Open questions allow patients to express their own thoughts and feelings, e.g. 'How have you been since we last saw you?', 'Is there anything else that you want to mention?'
Closed questions are requests for factual information, e.g. 'When did this pain start?'
Leading questions invite specific responses and suggest options, e.g. 'You'll be glad when this treatment is over, won't you?'

15. Reflecting questions help to develop or expand topics, e. g
Reflecting questions help to develop or expand topics, e.g. 'Can you tell me more about your family?'
Active listening encourages further dialogue, e.g. 'Go on,' 'I see,' 'Hmm' etc.
Requesting clarification encourages further detail, e.g. 'How do mean?', 'In what way?' etc.
Summarising ensures accurate understanding, e.g. 'Tell me if I've got this right.'

16. Gathering information
Encourage the patient to tell the story in their own words, from beginning to end.
Use open questioning initially; Tell me how your symptoms started?.
Move on to use closed questions for details.

17. Open and closed questions
Both types of question have their place.
Can we start with you telling me what has happened to bring you into hospital? (Opening)
Well, I've been getting this funny feeling in my chest over the last few months. It's been getting worse and worse but it was really awful this morning. I got really breathless and felt someone was crushing me.

18. Open and closed questions
Tell me a bit more about the crushing feeling. (Open questioning)
Well, it was here, across my chest. It was sort of tight.
And did it go anywhere else? (Clarifying)
No. Well, may be up here in my neck.

19. Open and closed questions
So what you are saying is that you had this tight pain in your chest this morning that went on a long time and you felt it in your neck? (Summarizing) . You said you've had the pain for the last few months. Can you tell me more? (Reflecting and open questioning)
Well, it was the same but not that bad, though it's been getting worse recently.

20. Open and closed questions
Can you remember when it first started? (Clarifying)
Oh, 3 or 4 months ago.
Does anything make it worse? (Open questioning)
Well, if I go up steps or up hills that can bring it on.
What do you do?
Stop and sometimes take my puffer.
Your what? (Clarifying)
This spray the doctor gave me to put in my mouth.

21. Can you show me it, please?
OK.
And what does it do? (Clarifying)
Well, it takes the pain away, but I get an awful headache with it.

22. Open and closed questions
So, for a few months you've had this tightness in your chest, which gets worse going up hills and upstairs and which goes away if you use your spray. But today it came on and lasted longer but felt the same. Have I got that right? (Summarizing)
No, it was much worse this morning.

23. Past medical history
Drug history-Allergy history
Family history
Social history
Systems review

24. THANK YOU