Large doses or prolonged use of certain medications can be associated with significant adverse drug reactions with relevance to the lower limb. He presented with a pruritic, inflamed lesion with a central black dot, under the free edge of the hallucal toe nail of his left foot. Dyspnoea (shortness of breath) may occur as a result of pulmonary oedema. A history of jaundice should alert the practitioner to the possibility of hepatitis, whereas a history of haemophilia, blood transfusion, foreign travel or intravenous drug use may place the patient – and thus the practitioner – at risk from a blood-borne infection. The past medical history (PMH) consists of information about previous lower limb problems and the treatment received, as well as details about any problems that have affected the patient’s general health. to maintaining your privacy and will not share your personal information without In the case of surgical treatment the practitioner must establish who is going to transport the patient to and from surgery and who is going to assist them through the immediate postoperative recovery period. A history of cardiovascular disease should be taken with respect to systemic, peripheral and haematological disease states, followed up by a review of symptomatology. History, social: An account of a patient that puts his or her illness or behavior in context. The use of injectable drugs places the patient at risk of hepatitis and human immunodeficiency virus (HIV) infection. Arch Intern Med. The past medical, family and social history may be documented by a staff member or on a form completed by the patient, as long as there is evidence that the biling clinician reviewed those. Treatment may fail or cause the patient’s presenting condition to worsen because inadequate history taking has prevented accurate diagnosis of the presenting foot complaint. It is not uncommon for patients to have taken prescribed drugs for many years with no clear understanding about why they are/were taking them. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. Problem Focused 2. The nature of the work should be determined (what they, Syncope (fainting) is a transient loss of consciousness. Rheumatic fever is a febrile disease occurring as a sequel to group A haemolytic streptococcal infections. Medical Summary Reports. With some types of treatment patients are required to reduce their activity level to a minimum, change dressings or administer treatments at home. Angina occurs as a result of atherosclerosis of the arteries to the myocardium and often coexists with atherosclerosis of the arteries to the lower limb. Step 07 - Social History (SH) This is the opportunity to find out a bit more about the patient’s background. Originally a native of the New World, it is now widely disseminated in Africa and Asia. Ask if they: • have Cut down on drinking – have tried repeatedly without success, • are Annoyed by criticism about drinking habits. Hospital records can provide this information but they are not always available. For one patient with COPD who came to the emergency department, the social history, with a simple question about pets, revealed crucial data. Other examples of adverse drug reactions are listed in Table 5.1. History of present illness (HPI) 3. Review of systems(ROS) 4. “My dog becomes visibly agitated and starts barking after smelling my breath when I'm getting sick,” she offered quickly when asked. The item(s) has been successfully added to ", This article has been saved into your User Account, in the Favorites area, under the new folder. This causes immediate destruction of the mast cell, which releases its contents, specifically histamine, serotonin, platelet-activating factor and slow-reacting substance. Anderson, Ruric (Andy) MD, MBA; Schiedermayer, David MD, Assistant dean for medical education, NorthShore University HealthSystem, and clinical associate professor of medicine, University of Chicago Pritzker School of Medicine, Evanston, Illinois; [email protected]. Gravity will force most of the transudate to collect bilaterally in the feet and ankles. Further questioning revealed that her weakness could more accurately be described as fatigue and heaviness of her legs walking to and from work. Please enable scripts and reload this page. A 23-year-old man attended clinic after 6 months of working as a volunteer in India. Use of recreational drugs should be recorded. Lack of home support may rule out certain forms of treatment. Once a history has been taken, physical examination and diagnostic tests can then be used to confirm the diagnosis and stage the severity of the condition. Refer to the British National Formulary (BNF) or another pharmacological text if you are unfamiliar with any drugs that the patient is taking. For example, upper and lower motor neurone lesions may cause an ataxic gait, in which coordination and balance are impaired. In particular, details of any adverse reactions, either by the patient or any member of the patient’s family, to previous local anaesthetic injections and other drugs (e.g. Social History (SH): This is a broad category which includes: Alcohol Intake: Specify the type, quantity, frequency and duration. Small plaques of brown lipid under the eyes, seen in hyperlipidaemia, are associated with atherosclerosis. Patients with acute foot or leg pain will walk with a limp as they try to ‘guard’ the injured part. 2. It publishes International Labor and Working-Class History. Many departments give their patients a health questionnaire to complete (see Appendix 5.1). a thrombosis or blood clot (deep vein thrombosis [DVT]), Angiotensin-converting enzyme (ACE) inhibitors, Central, crushing pain that radiates into the arms and jaw. History taking is as important as any diagnostic test or physical examination. It is not uncommon for patients to have taken prescribed drugs for many years with no clear understanding about why they are/were taking them. For more information, please refer to our Privacy Policy. Because it takes longer to fill the left ventricle, the pressure in the whole cardiac pulmonary system ‘backs up’, causing pulmonary congestion, reduced blood gas exchange and eventually pulmonary oedema. Certain lower limb pathologies can be inherited or seem to have a familial predisposition, especially diseases that are neurological in nature such as Friedreich’s ataxia and Charcot–Marie–Tooth disease. However, these patients are often more prone to injury because they are often not as fit and do not follow appropriate warm-up and warm-down regimens. Have you been off work due to illness for more than 1 week in the past 6 months? She was unwilling to compromise on the style of footwear she wore and provision of a suitable orthotic was impossible. Findings recorded with this system (Box 5.1) will determine the need for further clinical or laboratory investigation and indicate the patient’s suitability for a range of treatments. For example, aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) may precipitate asthma attacks. For example, prednisolone, commonly used in the treatment of rheumatoid arthritis, can reduce skin thickness and impair wound healing. Introduction 2. your express consent. patient’s medical history, inappropriate or unsafe treatment may be provided. The varied needs of older patients may require different interviewing techniques. Drinking before 10 a.m. is an important finding as it is associated with chronic alcoholism. Disorders of skin and nails may manifest themselves in the hand: for example, psoriasis and eczema may cause hypertrophy and anhydrosis of the skin; pulmonary or cyanotic heart disease may cause clubbed or hippocratic nails. N Engl J Med. • Did you have any major childhood illnesses? It is not known why some individuals are predisposed to anaphylaxis, though genetic mechanisms are certainly involved since there is a strong familial disposition. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. Past medical, family, and social history (PFSH) A chief complaint is required for all levels of charting. Hospitalisations for operations or injuries should be recorded and any complications noted (Case history 5.1). Poor history taking may result in a request for an inappropriate antibiotic prescription from a general practitioner for a patient who is sensitive to penicillin. If the exposure to the allergen is systemic, hypotension, bronchiole constriction, laryngeal oedema, swelling of the tongue, urticaria, vomiting and diarrhoea may follow. The approach outlined in this chapter forms the basis of a holistic approach to patient care. Depending on the PC it may also be pertinent to find out whether the patient drives, e.g. Are you exposed to passive smoking at home? Bendroflumethiazide, a useful diuretic for the treatment of cardiac failure or hypertension, can cause hyperuricaemia, which may result in gout-like symptoms. • need an Eye opener drink needed in the morning. The pain was on the anteromedial aspect of the plantar heel pad and had been present for some time. What do you smoke – cigarettes, cigars, a pipe? This information may prevent the repetition of tests or treatments which have previously been ineffective. Patients with. Examination revealed a hyperpronatory foot type. transient ischaemic attacks) or routine screening reveals a diastolic blood pressure above 90 mmHg. In some individuals, contact with certain allergens will stimulate the production of an antibody of the immunoglobulin E (IgE) class, which has the ability to adhere to mast cells in tissues and basophils in the circulation. Hypertension is a risk factor for many life-threatening conditions such as MI, renal failure and cerebral vascular accidents (strokes). Literally, her dog caused her to seek care. Many cardiovascular, alimentary, neurological and endocrine disorders can be inherited and therefore the use of pedigree charts is particularly useful in paediatrics. Patients with chronic foot disorders may shuffle rather than stride because a propulsive gait could cause more pain. Insect stings are also an important cause of anaphylactic fatality. The use of questionnaires gives patients time to consider their answers and reduces the time spent in taking a medical history during the consultation. Unfortunately, it is likely that those patients misusing alcohol are least likely to be forthcoming about their alcoholism. If a patient is still under the care of a hospital consultant it is prudent to inform the consultant before any treatment is given that may affect other body systems. deformity and possible neural compression. Certain rhythms such as ventricular tachycardia predispose to cardiac arrest. A 65-year-old woman attended the podiatry clinic complaining of weak muscles in her legs. Cf Family history. Registered users can save articles, searches, and manage email alerts. 30 mins. Sickle cell anaemia may particularly affect people of African or West Indian descent. Amphetamines, like many mood stimulants, have a vasoconstrictive effect. For immediate assistance, contact Customer Service: When patients are older, obtaining a good history—including information on social circumstances and lifestyle in addition to medical and family history—is crucial to good health care. Have you ever been under the care of a consultant or a hospital specialist? All forms of spina bifida should be noted even if the problem has been labelled as spina bifida occulta (impaired gait, pes cavus and plantar ulceration have been found to appear late in cases of spina bifida occulta). The patient should also be asked about dry retching in the morning, as this is a symptom of alcohol withdrawal. CHAPTER 5 The medical and social history I. Reilly Chapter contents 1. Bare concrete floors will exacerbate chilblains, whereas patients whose occupation involves standing on ladders will often suffer from chronic medial longitudinal arch pain. Get new journal Tables of Contents sent right to your email inbox, Articles in PubMed by Ruric (Andy) Anderson, MD, MBA, Articles in Google Scholar by Ruric (Andy) Anderson, MD, MBA, Other articles in this journal by Ruric (Andy) Anderson, MD, MBA, by the Association of American Medical Colleges. To determine the presence of systemic cardiovascular disease the patient should be asked if they have ever had: Ischaemic heart disease describes two clinical syndromes: angina pectoris and myocardial infarction (MI). • Have you ever been admitted to hospital? For example, repeatedly exceeding the recommended daily dosage of vitamins A and D supplements may. An illustrative poem or short work of literature can be incorporated into morning report or teaching rounds. Patients should be observed from the moment they enter the consulting room. Family history: especially parents, siblings and children. We must role-model how to take a social history for our trainees and peers. The actual risk of causing a bacteraemia in a patient with a prosthetic joint (which could infect and then loosen the joint) by performing nail surgery remains unquantified but a theoretical risk certainly exists. When it does occur it usually follows entry of an antigenic drug into the circulation of a sensitised individual. The tense tired face of those in chronic pain will appear similar to those suffering from depression. The patient had also noticed that climbing stairs causes a tight squeezing pain in her chest. This may manifest clinically as vertebral collapse, leading to spinal. Editorials of Laura Weiss Roberts, MD, MA, Addressing Race and Racism in Medical Education. Social History Assessment is the first resource to offer practical guidance about interpreting the social history. social history. She had noticed the weakness for some time, stating that if her symptoms continued to deteriorate she would have to give up her job as a school playground supervisor. The pain of angina is tight and pressure-like, precipitated by exercise and relieved by rest, and usually lasts for only a few minutes. The subsequent referral for a second opinion should be seen as part of the patient’s overall treatment plan. The consultation should begin with a handshake as considerable information can be gleaned from this simple contact. An increased risk of clinical emergencies. The actual risk of causing a bacteraemia in a patient with a prosthetic joint (which could infect and then loosen the joint) by performing nail surgery remains unquantified but a theoretical risk certainly exists. When an individual sensitised in this way is exposed on a second occasion to the allergen, the allergen combines with the IgE antibodies on the surface of the mast cells. Expanded Problem Focused 3. “So how is your son doing in college?” “Did you plant a garden again this year?”. Diagnosis: Congestive heart failure. Conventions exist regarding the symbols used in the charts. This condition can have a direct effect on the ability of the muscles to function under strain. _____ Birth/ Delivery: Was the child full term? Weight abnormalities affect the lower limb and should be noted on the first meeting with the patient. These patients are more likely to develop hamstring or calf muscle injury due to poor flexibility – the so-called weekend warrior. The patient should be asked if anyone else in the family has suffered from leg or foot problems. Patients with chronic foot disorders may shuffle rather than stride because a propulsive gait could cause more pain. Syncope (fainting) is a transient loss of consciousness. Detailed 4. All the body systems are worked through in a set order, which can be remembered using the acronym ‘CRAGCEL’ (see Box 5.1). Warfarin, an oral anticoagulant used for the treatment and prophylaxis of venous thrombosis and pulmonary embolism, increases clotting time and has obvious implications if surgical treatment is planned. 800-638-3030 (within USA), 301-223-2300 (international) The remaining three elements (HPI, ROS, PFSH) determine the type of history for the chart, as separated into 4 levels [2,3]: 1. Refer to the, Adverse effects of drugs affecting the lower limb, Patients should also be asked if they are currently taking or have taken in the past any tablets or medicine or used any ointments or creams which they have purchased from a chemist. Patients should also be asked if they are currently taking or have taken in the past any tablets or medicine or used any ointments or creams which they have purchased from a chemist. The Society for the Social History of Medicine, for example, founded in 1970, encourages membership from those ‘interested in a variety of disciplines, including history, public health, demography, anthropology, sociology, social administration and health economics’. Taking a history is a highly skilled exercise and one that requires practice to achieve and maintain competency. If drugs are prescribed (or omitted) in the absence of a detailed medical history, an existing condition may be exacerbated. It is important to consider the patient’s home situation. 1 Verghese A. H-LABOR is a daily email-based discussion group formed in 1993 that reaches over a … 2008;359:2748–2751. “My dog becomes visibly agitated and starts barking after smelling my breath when I'm getting sick,” she offered quickly … Active sportsmen and women may make the association between their sport and a lower limb problem, but those who participate in occasional sporting activities and hobbies may not. “The patient does not smoke and drinks occasionally.” This, sadly, is the patient's social history as recorded in too many of our medical records. Format of the medical and social history enquiry, Before history taking begins, the practitioner will gain some impressions about the patient’s current health status from simple observation. These questions will hopefully prompt the patient into recollecting any previous incidents of illness or surgery. Format of the medical and social history enquiry. 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And blood vessels, and manage email alerts the risk of bronchitis asthma! To complete ( see Appendix 5.1 ) drugs are prescribed ( or omitted ) in feet... Include fatigue and heaviness of her legs of pedigree charts is particularly useful in paediatrics an infection abroad! Has been successfully sent to the area to add if the patient is aware, enquire further about any cardiovascular. Be asked about dry retching in the family has suffered from leg or foot problems, of! Are giving consent to cookies being used having recorded disease states of which the patient s! Has been temporarily locked due to illness for more than 1 week in the absence of consultant! Practice to achieve and maintain competency employment history is your son doing in college? “. Compensate for this, first the heart rate and then the volume of blood filling the left ventricle.... “ Did you plant a garden again this year? ” medial band of the medial band the... 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