Histories
Start Here · Read This Before Any History Station
Every history station in this section follows the same structure — the one set out on this page. It does not change with the diagnosis. Whether the patient in front of you has claudication, dysphagia or a groin lump, you run through the same steps, in the same order, every single time.
The station pages that follow deliberately do not repeat this scheme. Each one gives you only the key questions specific to that presenting complaint — the differential-splitting questions, the red flags and the discussion points — which you ask on top of the generic history below.
A general rule that applies in every station: always follow an open question with closed, targeted
questions specific to the case and your working diagnosis.
The Scheme · The Whole Structure
Block 1 · The Complaint
1
Introduction
2
Presenting complaint — open question first, then SOCRATES (or the incident framework)
3
Systemic review — targeted at your differentials - aiming to rule out systemic disease
Block 2 · The Background
4
Past medical history
5
Drug history and allergies
6
Family history
Block 3 · The Person
7
Social history — lifestyle and circumstances
8
ICE — Ideas, Concerns, Expectations
1 · Introduction
“Hello, my name is Dr…, I’m one of the surgical trainees.”
“Could you confirm your name & date of birth for me, please?”
“Could you confirm your name & date of birth for me, please?”
2 · Presenting Complaint
“So, John, how can I help you today?”
“Can you tell me what brought you to the hospital?”
“Could you tell me more about this…?” — open question, always ask first
“Can you tell me what brought you to the hospital?”
“Could you tell me more about this…?” — open question, always ask first
Then elaborate — pick the frame that fits the presentation
SOCRATES — for any pain
S
Site
“Could you tell me where this pain is exactly?”
“Could you tell me where this pain is exactly?”
O
Onset
“When did it start? How did it start?”
“When did it start? How did it start?”
C
Character
“Could you describe this pain for me, please?”
“Could you describe this pain for me, please?”
R
Radiation
“Does it go anywhere else?”
“Does it go anywhere else?”
A
Associated symptoms
“Do you have any other symptoms?” — your bridge into the systemic review
“Do you have any other symptoms?” — your bridge into the systemic review
T
Timing
“Is it there all the time, or does it come and go?”
“Is it there all the time, or does it come and go?”
E
Exacerbating / relieving
“Does anything make it better or worse?”
“Does anything make it better or worse?”
S
Severity
“On a scale of 1 to 10, how severe is it?”
“On a scale of 1 to 10, how severe is it?”
3 · Systemic Review
Do not run the whole review. Screen the systems that could plausibly explain this presentation, then
target the ones that separate your differentials — e.g. eyes, skin and bowels in an irritable knee, to separate an inflammatory arthropathy from simple osteoarthritis.
Cardiorespiratory
Chest pain, breathlessness, palpitations, cough, ankle swelling
Gastrointestinal
Appetite, swallowing, nausea and vomiting, bowel habit, PR bleeding
Genitourinary
Stream and frequency, dysuria, haematuria, menstrual history
Neurological
Headache, weakness, numbness, dizziness, visual change
Musculoskeletal
Joint pain, stiffness and its timing, swelling, back pain
Skin, Eyes & Endocrine
Rashes, psoriasis, itching, red or gritty eyes, heat or cold intolerance
Always exclude malignancy. Ask about weight loss, appetite and tiredness in
almost every station — even when cancer is not your leading diagnosis.
4–6 · Past Medical, Drugs & Family
7–8 · Social History & ICE
7a · Lifestyle
- Smoking — “Do you smoke? How much, and since when?”
- Alcohol — “Do you drink alcohol?”
- Activity — “Tell me about your level of activity.”
7b · Circumstances
- Support at home — “Who do you live with?” and, in orthopaedic stations, “Are there stairs to get inside?”
- Mobility — especially in orthopaedic stations: “Do you use any sticks or a walker?”
- Work — “What do you do for a living? Is this affecting your work or social life?”
8 · ICE
- Ideas — what does the patient think is going on?
- Concerns — what specifically worries them?
- Expectations — what are they hoping for from this consultation?
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