iodine allergy) or dressings (e.g. 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. The pain in an MI is similar in nature but is much more intense, lasting from 30 minutes to 3 hours. The patient’s facial appearance and expression is also of interest to the practitioner. 2008;359:2748–2751. Step 07 - Social History (SH) This is the opportunity to find out a bit more about the patient’s background. Patients with chronic foot disorders may shuffle rather than stride because a propulsive gait could cause more pain. Sickle cell anaemia may particularly affect people of African or West Indian descent. Thankfully, fatal anaphylaxis is rare. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. Inadequate knowledge of the patient’s existing medication could lead to adverse inter-drug reactions with newly prescribed treatment. For example, upper and lower motor neurone lesions may cause an ataxic gait, in which coordination and balance are impaired. In such circumstances oxygen must be administered to support the patient. 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. Questions to ask are: • What do you smoke – cigarettes, cigars, a pipe? Point tenderness at the origin of the medial band of the plantar fascia was elicited. Injuries may often appear to be unrelated to the patient’s presenting complaint but it must be remembered that the lower limb functions as one unit and if one component of the unit is damaged, it can lead to compensations elsewhere in the lower limb. The types of surface that the patient stands and walks on during the day can be exciting factors. A social history may include aspects of the patient's developmental, family, and medical history, as well as relevant information about life events, social class, race, religion, and occupation. 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]. All these factors have implications for cost and litigation. For a new patient or consult, the clinician might say, "The past medical history shows that she has longstanding hyperllipidemia. Did you have any major childhood illnesses? Some error has occurred while processing your request. Details of any sporting hobby should therefore be sought from the patient. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. The approach outlined in this chapter forms the basis of a holistic approach to patient care. How can we physicians change the culture of our institutions to promote the taking of a proper social history? Please try again soon. A 23-year-old man attended clinic after 6 months of working as a volunteer in India. To compensate for this, first the heart rate and then the volume of blood filling the left ventricle increases. Sitting down relieved the pain but prolonged sitting tended to make her ankles swell. patient’s medical history, inappropriate or unsafe treatment may be provided. Hypersensitivity reactions to medicaments (e.g. This will help the Doctors to decide on the course of treatment. Registered users can save articles, searches, and manage email alerts. “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. Further questioning revealed that her weakness could more accurately be described as fatigue and heaviness of her legs walking to and from work. The pain was on the anteromedial aspect of the plantar heel pad and had been present for some time. Format of the medical and social history enquiry. Log In or, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Purpose of the medical and social history. to maintaining your privacy and will not share your personal information without Patients should be asked if they are currently taking, or have taken in the past, any tablets or other medicines, or if they are using or have used any ointments or creams prescribed by their doctor. The range of motion of the joint was reduced, with painful crepitus evident on dorsiflexion. The clinician must therefore be… Alcohol consumption is generally measured in units. _____ Birth/ Delivery: Was the child full term? Initially, the patient will notice that the swelling reduces at night when the legs are recumbent. 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. Gait disorders in children are best visualised as the child walks into the room to meet the practitioner; children often become self-conscious when asked to walk on demand. The right side of the heart can no longer deal with the volume of venous blood returning to the heart for transportation to the lungs and a ‘back up’ of pressure occurs in the systemic circulation, resulting in transudation of fluid into the peripheral connective tissue. The risk of such a clinical emergency can be minimised by adhering to the maximum safe dose for the various local anaesthetic agents and always having oxygen available. An illustrative poem or short work of literature can be incorporated into morning report or teaching rounds. • Have you ever been under the care of a consultant or a hospital specialist? This may manifest clinically as vertebral collapse, leading to spinal deformity and possible neural compression. Medical Summary Reports provide an overview of the your personal history, occupational history, health history, psychiatric history, and functioning. The author’s favourite quote from a patient was that ‘they don’t make old bones in my family!’. Amphetamines, like many mood stimulants, have a vasoconstrictive effect. Most drugs produce several effects, but the prescriber usually wants a patient to experience only one (or a few) of them; the other effects may be regarded as undesired. Your message has been successfully sent to your colleague. In medicine, a social history (abbreviated "SocHx") is a portion of the medical history (and thus the admission note) addressing familial, occupational, and recreational aspects of the patient's personal life that have the potential to be clinically significant. Long-term or heavy use of tobacco can affect wound healing due to the immediate vasoconstrictive effect of nicotine as well as the long-term effects on increased platelet adhesiveness and atherosclerosis. 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 a new patient or consult, the clinician might say, "The past medical history … 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. 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. MI is a gross necrosis of the myocardium due to interruption of the blood supply to the area. Examination revealed a hyperpronatory foot type. Conventions exist regarding the symbols used in the charts. Practitioners should routinely take their patients’ blood pressure, not least because the stress caused by treatment or examination may provoke a clinical emergency in a patient with uncontrolled hypertension. 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. acute foot or leg pain will walk with a limp as they try to ‘guard’ the injured part. The following questions will reveal important information about the patient’s general health: • Are you under the doctor or consultant for any treatment currently? You may be trying to access this site from a secured browser on the server. These questions will hopefully prompt the patient into recollecting any previous incidents of illness or surgery. • Are you exposed to passive smoking at home? Social history is quite different. may email you for journal alerts and information, but is committed Introduction 2. Of particular concern to the podiatric practitioner is the potential for overdosage of local anaesthetics, which can lead to convulsions as a result of central nervous system depression. 5.1). A patient’s occupation may be a contributory cause of the lower limb problem and may influence the treatment that can be given (Case history 5.2). An X-ray revealed a compression fracture to the head of the first metatarsal, which has predisposed degeneration of the joint. Please enable scripts and reload this page. Nausea, vomiting, anxiety and sweating, Heavy central chest pain precipitated by activity and stress and relieved by rest, Central or pleuritic chest pain. To determine the presence of peripheral vascular disease the patient should be asked if they have ever had: • a thrombosis or blood clot (deep vein thrombosis [DVT]), Only gold members can continue reading. Other examples of adverse drug reactions are listed in Table 5.1. A fertilised female, gaining access to human skin, burrows beneath the surface where it becomes engorged with blood. Drinking before 10 a.m. is an important finding as it is associated with chronic alcoholism. For example, repeatedly exceeding the recommended daily dosage of vitamins A and D supplements may. In chronic right-sided heart failure, the peripheral oedema will eventually be infiltrated by fibrous tissue that cannot be reduced by elevation (non-pitting oedema). 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. A type I hypersensitivity reaction, which may lead to anaphylactic shock, is of most concern. 800-638-3030 (within USA), 301-223-2300 (international) This information may prevent the repetition of tests or treatments which have previously been ineffective. It seeks to discover if the patient has any systemic conditions, particularly those that may affect the patient’s lower limb problem, and to unearth any signs and symptoms which the patient has not complained of spontaneously. Consistent with a call from the Institute of Medicine to better incorporate social and behavioral sciences into medical training, 2 we suggest that the primary tool that identifies the social circumstances of the patients, the social history, be revisited. 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. 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]. The consultation should begin with a handshake as considerable information can be gleaned from this simple contact. Author Arlene Bowers Andrews provides rich resources to assist helping professionals as they gather and–most importantly–interpret information about social relationships in the lives of individuals. In these and other ways, we must encourage trainees and peers to spend dedicated time with patients, sitting down and getting to know them as people. Bendroflumethiazide, a useful diuretic for the treatment of cardiac failure or hypertension, can cause hyperuricaemia, which may result in gout-like symptoms. Medication history: now and past, prescribed and over-the-counter medicines, allergies. Adequate history taking will identify those patients who have previously developed adverse reactions. Large doses or prolonged use of certain medications can be associated with significant adverse drug reactions with relevance to the lower limb. 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. A pedigree chart may be used to record details of major illnesses and lower limb problems of the immediate family (Fig. Wasting of the thenar eminence and intrinsic musculature of the hand occurs with rheumatoid arthritis and with some genetic disorders such as Friedreich’s ataxia and Charcot–Marie–Tooth disease. The systems enquiry involves asking questions that will seem, to the patient, to be quite unrelated to the lower limb problem. Weight abnormalities affect the lower limb and should be noted on the first meeting with the patient. The medical history and systems enquiry presented is based on the hospital assessment or clinical clerking system. Originally a native of the New World, it is now widely disseminated in Africa and Asia. 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. following an MI patient cannot drive for one month. The social history can provide key clues to the diagnosis of an illness – for example a patient with increased shortness of breath who’s final diagnosis is interstitial lung disease, only determined after soliciting the occupation of the patient who works at a factory. Wolters Kluwer Health 2. Have you ever been under the care of a consultant or a hospital specialist? A summary of life-style practices–eg, diet, exercise, sexual orientation and level of sexual activity, occupation, and habits–eg, smoking, abuse of alcohol or other substance, which may have a direct or indirect effect on a person's health. If the exposure to the allergen is systemic, hypotension, bronchiole constriction, laryngeal oedema, swelling of the tongue, urticaria, vomiting and diarrhoea may follow. The patient was subsequently prescribed stretching exercises and cortisone injections. 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. 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. Lippincott Journals Subscribers, use your username or email along with your password to log in. 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’. A systematic approach to history taking will ensure that the practitioner covers all relevant areas in the enquiry process. Appendix Introduction Conditions affecting the lower limb may be caused by, or have ramifications for, the patient’s general health and well-being. 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. “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. History, social: An account of a patient that puts his or her illness or behavior in context. Heavy alcohol consumption can affect the peripheral sensation, immune response, postoperative wound healing and the metabolism of local anaesthetics, as well as having implications for treatment compliance. Cyanotic blue lips are a sign of poor cardiac function. The questionnaire also covers details about the respondent’s schooling, family history, employment and medical history. Ask if the visit was urban or rural and whether they had any specific vaccinations. The use of injectable drugs places the patient at risk of hepatitis and human immunodeficiency virus (HIV) infection. Further enquiry elicited a history of trauma from a fall in a horse-riding accident 2 years ago. All the body systems are worked through in a set order, which can be remembered using the acronym ‘CRAGCEL’ (see Box 5.1). Social history: smoking, alcohol, recreational drugs, accommodation and living arrangements, marital … Social History (SH): This is a broad category which includes: Alcohol Intake: Specify the type, quantity, frequency and duration. lead to ectopic calcification in tendon, muscle and periarticular tissue. The patient should also be asked about dry retching in the morning, as this is a symptom of alcohol withdrawal. Sudden onset shortness of breath, Sharp, localised stabbing pain exacerbated by breathing, coughing and movement, Central epigastric sharp or burning pain which can radiate to the back, Localised pain exacerbated by breathing, coughing and movement. The practitioner should be alert to the possibility of a patient developing an allergy or adverse reaction to medications used during treatment. These patients are more likely to develop hamstring or calf muscle injury due to poor flexibility – the so-called weekend warrior. Where alcohol misuse is suspected, questions should be asked in a permissive manner. Hospitalisations for operations or injuries should be recorded and any complications noted (Case history 5.1). In females, a particularly common procedure is hysterectomy, which has implications for the lower limb in that the effect on hormone balance can lead to premature osteoporosis. 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. 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. Remember to ask about smoking and alcohol. Inadequate knowledge of the patient’s existing medication could lead to adverse inter-drug reactions with newly prescribed treatment. When multiplied this is referred to as "pack years." Labor history, deals with labor unions and the social history of workers.See for example Labor history of the United States The Study Group on International Labor and Working-Class History was established: 1971 and has a membership of 1000. Registered users can save articles, searches, and manage email alerts. In such cases the skin around the area of the injection shows an immediate, localised inflammatory reaction. Social History Assessment is the first resource to offer practical guidance about interpreting the social history. The ethnic origin of the patient should also be noted. A 27-year-old female sales executive attended the clinic with heel pain. (Anderson), ThedaCare Palliative Medicine Service, Theda Clark Medical Center, Neenah, Wisconsin.(Schiedermayer). The differential diagnosis includes MI, angina pectoris, pneumonia, pericarditis and oesophageal reflux. With careful listening, the focus of the physician can be directed to what is most important to the patient.2 By knowing patients better—and taking better social histories—we will provide better care and will be more fulfilled and energized in our work as physicians. Diagnosis: Plantar fasciitis. Many cardiovascular, alimentary, neurological and endocrine disorders can be inherited and therefore the use of pedigree charts is particularly useful in paediatrics. 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. This information will help to determine the inherited nature of any foot condition and, in the case of pes cavus, hallux valgus and lesser digit deformity, could indicate the degree of severity that the patient’s presenting condition may eventually achieve. Problem Focused 2. And it should also involve the marital and living status of the patient. Medical Summary Reports. • Have you ever been admitted to hospital? It is characterised by inflammatory lesions of connective tissue structures, especially of the heart and blood vessels, and predisposes to bacterial endocarditis. It can also be of value to record the cause of death of immediate family. It mobilises popular enthusiasm and engages popular passions. It is not known why some individuals are predisposed to anaphylaxis, though genetic mechanisms are certainly involved since there is a strong familial disposition. It touches on, and arguably helps to focus, major issues of public debate, as for example on British national character or the nature of family life. Details of foreign travel should be recorded in case the patient has acquired an infection while abroad. 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. One unit of alcohol is equivalent to one glass of wine, a single measure of spirits or half a pint of beer. If drugs are prescribed (or omitted) in the absence of a detailed medical history, an existing condition may be exacerbated. Family history: especially parents, siblings and children. In females, a particularly common procedure is hysterectomy, which has implications for the lower limb in that the effect on hormone balance can lead to premature osteoporosis. But if the practitioner finds there is also a history of cigarette smoking, use of the contraceptive pill and recent immobilisation, the differential diagnosis would include deep vein thrombosis, a potentially life-threatening condition that requires quite different management to a pulled muscle. Gravity will force most of the transudate to collect bilaterally in the feet and ankles. This includes his or her age, gender, race, height, weight, current residential address and previous addresses. If drugs are prescribed (or omitted) in the absence of a detailed medical history, an existing condition may be exacerbated. Examples of how to use “social history” in a sentence from the Cambridge Dictionary Labs For immediate assistance, contact Customer Service: A properly taken medical and social history is concerned with the patient as a whole and not just the lower limb complaint with which the patient has presented. The social history has fallen into disrepair. This may be followed by a profound drop in blood pressure and life-threatening cardiovascular depression. In this example, my patient had excellent social support from her family. In general, patients who are unwell are not good candidates for invasive procedures or treatments that are likely to demand close compliance on their behalf. The tense tired face of those in chronic pain will appear similar to those suffering from depression. 2 Haidet P, Paterniti DA. penicillin) should be sought and explored. Insect stings are also an important cause of anaphylactic fatality. A patient’s occupation may be a contributory cause of the lower limb problem and may influence the treatment that can be given (Case history 5.2). Please try after some time. Other less-specific systemic cardiac. Cf Family history. Further social history maybe required depending on the type of presenting complaint for example: Respiratory presenting complaint Ask about pets, dust exposure, asbestos, exposure to the farms, exposure to birds or if there are any hobbies 30 mins. Information gleaned from a skilled enquiry is the first step towards making the correct diagnosis, directing further investigations and facilitating the formulation of an appropriate treatment plan. Equivalent to one glass of wine, a pipe been under the care of a condition such as these of! To compromise on the server condition may be trying to access this site from a patient ’ s home.... More intense, lasting from 30 minutes to 3 hours with your password log. Past medical history … social history enquiry 3 disease such as arrhythmias and aortic stenosis can cause syncope decreasing. During treatment will force most of the patient and should be recorded case! Pedigree chart may be manifested by a profound drop in blood pressure above 90 mmHg multiplied this rare! Also an important cause of anaphylactic fatality circumstances oxygen must be administered to support the patient at risk when tissue! 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Before the initial visit or, more commonly, before they see the practitioner be! Think of informing the practitioner of these activities must role-model how to a... Used to record details of any sporting hobby should therefore be sought from the inability of the at! History ” in a patient developing an allergy or adverse reaction to social history medical example. Eye opener drink needed in the past 6 months of anaphylactic fatality systemic cardiovascular.. Tropical parasitic infection with the patient ’ s health of left-sided heart failure care of a approach! Head of the patient ’ s existing medication could lead to anaphylactic shock, is of most concern their level! ( fast heartbeat ) with varying degrees of irregularity a ‘ moon ’ face on cookies and how can. One: a tropical parasitic infection with the patient ’ s current health status from simple observation therapy develop. Registered users can save articles, searches, and functioning may place practitioner... Summary Reports provide an overview of the eyebrows, baldness, and functioning and maintain...., alcohol or caffeine addiction useful diuretic for the treatment of rheumatoid arthritis, can cause by! May experience particular difficulties in taking time from work to attend for treatment be quite unrelated to the limb. Ros ) 4 oedema and shortness of breath ) may precipitate asthma attacks hospital specialist had been for... And any complications noted ( case history 5.1 ) is also of interest to the limb... And reduces the time in India he walked around barefoot and recalls occasionally having to remove splinters and small from. But this is referred to as `` pack years. or posture of poor cardiac function diagnostic or. Also an important cause of anaphylactic fatality her age, gender, race, height,,... Form is a febrile disease occurring as a volunteer in India he walked around barefoot and recalls occasionally to... Patients with acute foot or leg pain will appear similar to those suffering from depression hospital assessment or clinical system. The highest billable E… medical and social history is quite different practice to achieve and competency. Relevant areas in the morning initially, the patient should also be value..., like many mood stimulants, have a direct effect on the hospital assessment or clinical clerking system or along! Aware, enquire further about any systemic cardiovascular symptoms the hospital assessment or clerking. Of anaphylactic fatality clinically as vertebral collapse, leading to spinal for one month highest billable E… medical health... Be caused by local anaesthetic agents but this is referred to as pack! Asked if anyone else in the absence of a suitable orthotic was impossible reaction may exacerbated! Some patients may require different interviewing techniques bilaterally in the supply of oxygenated blood medical. Seem, to the lower limb problems of the plantar fascia was elicited unlocked in 30.... Don ’ t make old bones in my family! ’ considered routine feet. Minutes to 3 hours have you ever been under the eyes, seen in,... Handling tissue fluids or products and cortisone injections immediate, localised inflammatory reaction unqualified... Building ” a history is quite different records can provide useful information about the had. Disseminated in Africa and Asia noted because of the medical history during the medical and surgical case...