7 cardinal features of a complaint
OPPQRST
O = onset
P = provoking
P = palliating
Q = quality
R = radiation
S = severity
T = timing
Five steps to a focused history
1. First: 7 cardinal features of a complaint
2. Then: Pertinent (+) (-) ROS
3. Then: Why today?
4. Then: Impact on function?
5. Finally: Pertinent PMH, FHx, Social Hx
Onset
- when did it start?
- what happened when it started?
- ex. sudden, gradual
O of OPPQRST
Provoking
- what makes it worse? (open-ended q)
- after open ended, offer specific suggestions based on your differential
P of OPPQRST
Palliating
- What makes it better?
- What have you tried?
- how were you using it? If tried meds: name, dose, freq, route
- After open ended, offer specific suggestions based on your differential
P of OPPQRST
Quality
- can you describe how this feels to you? (open-ended q)
- offer adjectives if needed (to help narrow DDx)
Q of OPPQRST
Radiation
Location of pain
- where is the pain now? point with 1 finger
- does it travel anywhere else?
- may need to be modified or exclude based on CC
ex. cough & dizziness do not radiate
R of OPPQRST
Severity
- RATE pain/symptom on a scale of 1-10 with 10 being the worst pain you have ever experienced
- if not a pain complaint, how much is the sx bothering you? how does this impact your daily life?
S of OPPQRST
Timing
- what is the pattern of pain (related to time)?
- have you noticed a patterm to your pain, cough, dizziness, etc, in relation to the time of day?
- ex. constant, intermittent, worse at night
T of OPPQRST
definition of positive & negative ROS
asking about the presence OR absence of symptoms that may help explain the complaint
- positive ROS = presence
- negative ROS = absence
selecting ROS to include in a focused hx
1. what body system is the complaint directly related to?
2. what body systems live in the neighbor hood?
3. what other body systems are often involved with your top 3 differential diagnoses?
ex. chief complaint: chest pain
1. CV ROS; 2. ask GI, Pulm 3. i
Why Today, Had Before, & Impact
why today:
- if chronic: "Did anything happen that made you want to come in to get checked out today?"
- "ever experienced anything like this before?"
- impact: "What are some things you wish you could do that you can't do now because of this?
focused hx documentation structure
start w/ chief complaint "in their own words" x duration
then focused hx compoents:
1. introductory statement
2. OPPQRST
3. (+) (-) ROS, why today? had before? impact?
4. Pertinent PMH, Fhx, Social hx
then move into objective: vitals, general statement, P
PMH focused hx components
Always ask:
1. adult illnesses
2. meds: Rx, OTC, anything should be taking but isn't, regular health practices
3. allergies: food, enviro, meds including reaction
4. hx maint: last physical exam with any related labs/tests as they relate to the complaint
FHX focused hx components
Always ask
1. the big 5: CAD, HTN, DM, MDD, CA
2. ask questions specific to the CC to help you narrow your DDx
ex. if abdominal pain CC, ask if any family members have GI issues
ex. family history negative for ____
Social HX focused hx components
Always ask:
1. past and present tobacco, ETOH, illicit
2. stress
3. diet and exercise
4. ask anything else that will help you narrow your DDx
ex. Social history if notable for _____