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LEARNING OBJECTIVES

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  1. Describe the different types of patient histories.

  2. Conduct a chief complaint history using LOQQSAM to assess patient’s suitability for self-care or need for referral to a higher level of care.

  3. Conduct a chief complaint history using LOQQSAM to assess the presence of an adverse reaction to medications.

  4. Conduct the interview used in a follow-up visit for patients with a chronic disease such as diabetes mellitus.

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INTRODUCTION

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Much of the information needed to accurately assess a patient’s symptom complex is obtained from the patient’s history, acquired by interviewing the patient in a structured method. Because the patient is telling their story, patient histories are referred to as subjective data, whereas laboratory tests, medical imaging test results and the physical examination, are called objective data. The general process to obtain a patient history by the pharmacist starts with broad open-ended questions to begin the interview, followed by more focused open-ended questions to obtain more specific information. Finally, closed-ended questions are used to assess key issues that may be important to the differential diagnosis, but not mentioned earlier in the interview by the patient, or to further clarify information previously obtained. Next, the pharmacist summarizes the information in the history, which allows the patient to verify the accuracy of the pharmacist’s comprehension of the answers they have provided. Closed-ended questions are those that can be answered with a yes or a no and open-ended questions require a more detailed answer in the patient’s own words. Open-ended questions are preferred because their use provides more extensive information than do closed-ended questions. Psychologically, closed-ended questions are generally perceived as a notice that the conversation will be coming to an end soon.

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TYPES OF HISTORIES (Table 2.1)

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TABLE 2.1

Types of Patient Histories

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Patient histories can be patient-oriented or provider-oriented. Patient-oriented histories explore the patient’s feelings regarding the physical aspects of the symptoms, personal or social components of the symptoms, and the patient’s emotional reactions to the symptoms or disease, with the interviewer liberally using empathy, plus verbal and nonverbal cues such as silence and nodding to get the patient to tell their story. A skilled interviewer using both listening skills and observing nonverbal clues can obtain much of the same information that is obtained using a provider-centered process, plus key elements about other aspects of the illness. However, the interview is controlled mostly by the patient and their agenda and can take more time than other approaches. Provider-centered patient histories are designed to get specific types ...

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