A 29-year-old male presents to his primary care physician with complaints of intermittent abdominal pain and alternating bouts of constipation and diarrhea. His medical chart is not significant for any past medical problems or prior surgeries. He is not prescribed any current medications. Which of the following questions would be the most useful next question in eliciting further history from this patient?
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- “Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life”
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- “Is the diarrhea foul-smelling?”
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- “Can you tell me more about the symptoms you have been experiencing?”
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- “Does the diarrhea typically precede the constipation, or vice-versa?”
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- “Are the symptoms worse in the morning or at night?”
0 voters
EXP:
Open-ended questions are the best way to elicit a history from a patient. Closed-ended questions may be appropriate as follow-up or clarification after the patient is given sufficient opportunity to provide an uninterrupted history.
Open-ended questions have been shown to improve the accuracy of a patient’s history, including even specific components such as an accurate medication list. At the beginning of the interview, it is important to avoid yes/no or dichotomous questions and let the patient relay what he or she sees as the most important elements to their history. This is not to say that closed-ended questions should be avoided, rather, they should be reserved for later in the history-taking process for follow-up questions or further clarification on an issue. Often, for very talkative patients or patients who often diverge onto tangents, a more directed, closed-ended history taking style is appropriate and necessary.