A line of questioning that we follow each and every time to get the answers we need.
Following the same method for each patient ensures not only consistency in our history-taking, but also in our treatment of the patients.
Personally, it guarantees that I have asked all the questions, at least the basic ones, to know where to start and which line of treatment is the most likely.
History taking involves everything from past medical problems, to current drug treatments, from the time of the last meal to bowel opening patterns, from sleeping patterns *ahem* to the actual current reason for calling the ambulance.
And then, there's pain related questions. Where is it?
How bad is it?
When did it start?
Does it move?
What were you doing when it started?
Does anything make it worse? Or better?
All in order. Need to keep my stride.
It's especially important towards the end of a night shift, and even more so towards the end of a set of nights.
My favourite pain-related question, probably because the answer is invariably "No", is "Have you taken anything for the pain?"
You know, any analgesia or anti-inflammatory stuff? Anything that might have helped you get the night's sleep that you're complaining you didn't get? I'm always a little bemused by people who go from having a pain that they can cope with straight through to excruciating-ambulance-required-immediately pain without going through the lets-take-some-tablets-and-see pain in the middle.
I digress. Must try to keep my stride.
The following is a true, if slightly shortened, recording of a recent conversation with a patient in pain.
InsomniacMedic: "When did the pain start?"
Patient in Pain: "About 12 hours ago". That would have been at the more tolerant and alert part of my shift.
IM: "And you haven't slept at all?"
PIP: "Not a minute."
IM: "Did you take anything for the pain?"
IM: "Can I see the tablets that you took?"
PIP: "It wasn't a tablet." Assuming that this patient can't swallow tablets, I presume it must be a liquid. Exasperation is slowly setting in.
IM: "Can I see the bottle then?"
PIP: "It wasn't a bottle." Exasperation is slowly being followed by the loss of will to live.
IM: "So what did you take for the pain then?"
All the training, all the working on a system, all the pre-planned questions, all down the toilet.
I mean, with answers like that, how is a guy supposed to keep his stride???
I think I need a drink.
And not necessarily a coffee.