Establishing patient history
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Mark, how do we establish a patient's history, again, what can we look at? What tips can you give us as to get a good patient history?
Quite often people who come to the hospital do have a medical history, things that they are known to suffer with, they are known as chronic illnesses. And what can happen is they can have that particular chronic illness gets a little bit worse and so that is called acute-on-chronic. So the history is important there, history is really, really important, but the thing we need to know is what has changed, why today, what is different about today? Why have they come in today?
So we are trying to basically find out the bigger picture as to what they have suffered with and is that linked to why they are here today. And if it is, what has changed, what has got worse, what has got better and is it linked at all? It may be something, I presume, completely different.
It could easily be, yeah. There is a trap that it is important not to fall into when triaging, going too far into history, too far... Some people, leading up to the day they present in A&E, it could have started a year ago, but we do not necessarily need to know everything that has happened every day in between, we need to know what has changed and what is the history concisely.
Okay, so we are not trying to find every ailment of this person... My understanding is, if you ask too many questions, people will start to get led off down routes that actually are not relevant to what they are here with today and we do not want to get them triaging down a pathway that is of no consequence to what they are herewith.
We need to try and keep it as concise as what they have come in with and not expand too much, but rule out and rule in different particular areas. Would that be correct?
That is right. And again, you are sorting, checking the severity and how this relates to their past medical history, really. Body language comes into that, when this starts happening, you start going down these routes that are not really productive in terms of triage, your body language can come into that, you can stand up, some people are advocating triage should be done standing up, that it is a quick action assessment. And of course, you can... Without interrupting and being rude to somebody, you know, if a skilled triage clinician can bring it all back really quickly and say, "Okay, so what is happening?"
So you are in control of the triage, basically, you are ruling out what... If for all intents and purposes, we do not want a waffle, we want clear, accurate findings.
Yeah. Well, people, they are very good at absolving themselves of any self-responsibility and so when it is on the computer, you know, so are they are saying they do not really know or they do know or they are being awkward.
What do they know about their own history?
So it is making that clear that the triage is like a clean assessment really and what the patient tells you, that is all you have got to go with, we have not got time to be looking into 20 years' history.
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