Red flags
o When someone comes with ____, of course there are a lot of causes.
There are a few specific Qs we’d like to ask just to make sure nothing
worrying is going on
• Psychosocial/Personal & Social Hx
o Mr X, we’ve not met each other before before, I’m just gonna ask you a
few Qs about you and your lifestyle. Sometimes they could affect ____
o Mr X, it might seem a little bit odd Q to ask, but sometimes things like
alcohol and smoking can influence ____ Can I check if you do any of
those?
o Mr X, it might seem a little bit odd Q to ask, but sometimes when people
feel anxious/depress, they can turn to things that they think might help,
for example smoking/drinking alcohol/taking drugs, Can I check if you do
any of those?
o
• ICE
2nd Half
• Management
• Address patient Concern brought up in the 1st half (E.g. Pt concerned about ca)
• Chug and Check (make it 2-way conversation)
o Does that make sense?
o How does that sound so far?
o Any questions?
o Let me know if I’m too fast?
o Are you following me?
Vocalize Cues/emotions
• Is everything ok?
• I can see that this is difficult for you
• I can see that you’re embarrassed to talk about this/with the situation
• I can see this is frustrating you
• I know the questions that I’m asking you are quite annoying at times
• Acknowledge concern and address immediately, come back to that later
o E.g. Back pain: In 1st half pt mentions “Work is difficult” – Acknowledge
here “You mentioned work, I’ll come back to that in a minute, that’s
obviously quite important to talk about”. Continue Hx taking in 1st half,
ask later in detail.
3 R
• Reasoning: Signpost when about to ask about red flags
o “When it comes to _____, there’s a few specific Qs we would like to ask
just to make sure everything is okay”
• Reflection: ICE, don’t give answer, reflect back things in pt’s mind
o Idea: “Some people come with _____, there’s a lot of different causes,
just wondering have you any thoughts as to what’s going on with yourself
with this ____”
o Reflect: “You’re right, _____(e.g. cough) could be a clear sign of
_____(e.g. infection), it’s something we’re looking into”
o Concern: “Is there anything particular worrying you about this ____”
o Reflect: “You’re absolutely right, ____ can be a sign of _____(e.g. Ca),
it’s really good that you’ve come to check this out, just so you know
_____ is quite rare, but we’ll certainly make sure there’s nothing like
that going forward”
o Expectation: “When you came in, of course we’re gonna try to check
you over to see what’s going on, was there anything you thought we
could do for you today”
o Reflect: e.g. Abx “Absolutely, we do use Abx to treat certain types of
chest infections, so maybe we’d want to examine you to check you over
so we can see if that’s reasonable or not”
• Empathy/sympathy
o I can see it’s been a difficult time for you