Transcript Comprehensive Clinical Assessment – Pediatric Station

Pediatric History: Tips
John Schmidt, MD
Pediatric Hospitalist
The Pediatric History
General Tips
– Remember to address the patient and parents
by name
– Introduce yourself by name
– Use open-ended questions
– Keep the interview organized
Under stress, it will help you keep your focus
Decreases the chances of you forgetting
something
General Tips (continued)
Avoid medical jargon
Occasionally summarize sections of your
history
– Helps you to identify aspects which may not
make sense/things you missed and prompt
further questioning
– Lets the parent know that you have been
paying attention
General Tips (continued)
A good portion of Pediatrics is not just the
treatment of the patient, but also the
parent
– Parents are under stress and often feel guilt
over their child’s illness (“Could I have done
something different?”)
– Acknowledge these feelings
– Support positive behavior
– Ask for whatever questions/concerns they
may have
Chief Complaint/HPI
“What brings you in today?”
You are a reporter…literally. Your job is to
objectively collect the facts
As a self check, have you asked enough
questions to accurately portray the child’s story
to your reader? Can they close their eyes and
replay the child’s course?
Check your facts/source – Is the patient really
sick?
– E.g. How do you know your child had a fever?
– E.g. What do you mean by feeding poorly?
Chief Complaint/HPI (continued)
Start at the beginning….
– When did the symptoms start?
– What was the child doing?
– Did the symptoms come on suddenly or gradually?
What happened then?
– Have the symptoms been constant or intermittent?
– If intermittent, how bad are the symptoms when they
do occur
– When they do occur, how long do the symptoms last?
A few minutes? A few hours?
Chief Complaint/HPI (continued)
Associated symptoms
– It is helpful to have your differential diagnosis
in mind when you are asking questions –
Every positive or negative answer should
provide focus to your assessment
– Start with broad categories/systems and then
fill in what might fit the story within that system
Past Medical History
Learn from the past – is there a clue to what is
going on now and what is going to happen?
Has this happened before? If this happened
before, when? Did you see an MD? What did
they think?
Is the patient a setup for something?
– Did the patient miss immunizations?
– Previous surgeries?
– Is there an underlying disorder that could be playing a
role?
Past Medical History (continued)
Your “crystal ball” - How bad was it in the past?
Do we need to worry now?
– Were they sick enough that they needed
medications? If so, what?
– Were they sick enough that they had to come into the
hospital?
– Were they sick enough to need an ICU?
– Were they so sick that we had to support them?
Don’t reinvent the wheel
– What worked in the past? Certain meds (e.g.
steroids)? Certain procedures?
Medications
May be a clue to his symptoms
Helps guide your intervention
– What is the patient on/received already? – May get
past medical history that was already missed
– Has the patient already started treatment?
– Have the interventions helped? – CLUE!
Example: Did he just complete a course of antibiotics?
Example: Did he already receive his max- dose of Tylenol
today?
Example: Has he already received NMTs? How often?
– Allergies
Family/Social History
Might increase your pre-test probability for a
diagnosis
Think through your differential and anything
which may have a genetic component
Who is at home?
What is at home/in their life i.e. exposures –
Pets? Smoking?
Do you have a complete picture of his day?
Next Steps – Diagnostic
Workup/Treatment
Is he symptomatic now? Do you want to
do anything about it?
Think about your differential – Does your
work-up address the most likely suspects?
– Lab work
– Diagnostic studies
– Procedures