History Taking
So you would have all heard of the much loved SOCRATES (site, onset, character, radiation, associated symptoms, timing, exacerbating factors and severity) for pain. And it’s great right? When I first learnt it, I thought it was the best thing since sliced bread!
However, during one dreary lunchtime teaching session back in the beginning of my clinicals, my renal consultant taught me something that revolutionised my medical career. I’d go so far to even say, it is the single most used tool of my medical career. And now, I’m going to share that with you! Essentially, it’s a history taking matrix that is organised much more logically than SOCRATES and also can be used for virtually any presenting complaint (PC), not just pain! The matrix is 3x3 and is explained below. Click here for the info-graphic and click here for the video.
Top line
1. Site (where does it hurt?)
2. Sort (describe the pain to me e.g. deep or superficial, stabbing or dull, does it go anywhere/radiate).
3. Severity (scale of 1-10, 10 being the worst, how painful is it?).
You can even extend this to other PCs other than pain, like cough. For example, sort (describe the cough/ what does it sound like?), severity (how bad is the cough, can you not complete sentences?) etc.
Middle line
4. Onset (When did the PC begin? Was it sudden or gradual? Does anything trigger it? Etc.).
5. Duration (How long has the PC being going on for? How many times a day does it happen?).
6. Progression (Has it been getting better or worse?).
Bottom line
7. Associated symptoms (Sx)/ factors (Any other sx associated with the main PC?).
8. Exacerbating (anything makes the PC worse? E.g. position etc.).
9. Alleviating (anything makes the PC better? E.g. medication, position etc.).
By using this matrix, I’ve managed to score very highly in my OSCE’s (practical clinical exams) every year and it also gives me a good framework to rattle through without having to worry about the next question. I then ask more targeted questions depending on the patient’s answer. This is a good starting point and good system to engrain into your practice! Click here for the info-graphic and click here for the video.
