How and When?

• How and When?

  • History of present condition
  • Past medical history
  • Medication
  • Special questions
• The History of Present Condition (HPC)

  • Time of onset
  • Mechanism - trauma or insidious
  • Possible causes
  • Swelling - how quick?
  • Pain immediately?
  • Any treatment / investigations?
  • Development of symptoms
  • Better/same/worse
  • Previous episodes / treatment
• Past medical history

  • Major operations/accidents/illnesses
  • General health/weight loss
  • Epilepsy/ Diabetes/ Asthma/ Malignancy/ Thyroid problems
  • Heart/Blood pressure/respiratory
  • Fractures
  • History of joint disease
  • X-rays/ MRI /other investigations
• Drug history

  • All current medication
  • Effects, side effects, contraindications
  • Steroids
  • Anticoagulants
  • Pain relief – adequate?
• Family History

  • Hereditary diseases
  • Genetic predisposition to various pathologies
  • Previous experiences form health beliefs
• Social history

  • Occupation
  • Is your patient off sick? Were they injured at work?
  • What do they do?-sitting at desk, lifting, driving, standing, leaning over workstation, close work
  • Can they take breaks?
  • Leisure
  • Sedentary or active
  • Risky hobbies – e.g. contact sports, repetitive actions/postures
  • Home responsibilities
  • Lifting elderly parents, disabled children, young children
  • Sources of physical/mental stress
• Special questions

  • Paraesthesia - cough/sneeze
  • Anaesthesia - headache / dizziness / nausea / blackouts
  • Bowel/bladder - Locking / giving way / swelling / crepitus
  • Unsteadiness - Unexplained Weight Loss