Woman (pregnant (trimester) / breast (how often)) Elderly Child

SELF or someone else Appearance (ill looking, lethargic child)

REQUEST for product REQUEST for symptom help NEW prescription medicinePOM register

Have you used the medicine before?

YES: any further info needed?

NO: REQUEST for symptom helpHow has he come to request this product?

POM register

I am sure I can help.To help me give the best advice, though,I’d like a bit more information from you, so I need to ask a few questions. Is that OK?

SYMPTOMS: Could you tell me what sort of trouble you have had........?

Duration !....For how long How and when it began, Timing of symptoms How it has progressed What have you tried so far ?

Any other symptoms or anything different from usual

Decision: REFERRAL Danger,Duration, Incomplete info

TREATMENT: effective and safe(medical history and medicine use)(age restriction)

OUTCOME: improvement within usually 1 week, otherwise DOCTOR

CD register, dispensing history

Hello.Thank you. I will quickly process the prescription.

Is this prescription for you?Is this a new prescription for you ?What has your doctor told you ?

WHO

Could you just tell me what sort of trouble you get with your piles?

I’m not sure I quite understand when you say . . . , or I’m not quite clear what you meant by . . . . I’d just like to make sure I’ve got it right. You tell me you’ve had this problem since . . .

Also ask then some more direct questions to exclude danger symptoms

Other questions could include what treatments have you tried so far this time? What sort of treatment were you hoping for today?What other medications are you taking at present? Do you have any allergies?

REFERRAL:Long duration of symptoms Recurring or worsening problems Severe painFailed medication (one or more appropriate medicines used already,without improvement)Suspected adverse drug reactions (to prescription or OTC medicine) Danger symptoms.For accidents and injuries:_ The person is, or has been, unconscious.There is a suspected broken bone or dislocation.The person is experiencing severe chest pain or is having trouble breathing.The person is experiencing severe stomach ache that cannot be treated by OTC remedies.There is severe bleeding from any part of the body.

e.g. History taking is particularly important when assessing skin disease. For example the use of a topicalcorticosteroid inappropriately on infected or infested skin may substantially change the appearance; allergy to ingredients such as local anaesthetics may produce a problem in addition to the original complaint.The attacks of heartburn that occur after going to bed or on stooping or bending down are indeed likely to be due to reflux, whereas those that happen during exertion such as exercise or heavy work may not be. In recurrent mouth ulcers, for example, do the current ulcers resemble the previous ones, was the doctor or dentist seen on previous occasions, was any treatment prescribed or OTC medicine purchased and, if so, did it work?

A complete medical historyconsist of five components: history of present illness (HPI), past medical history, family history, personal/social history, and a review of systems. The HPI, also known as a chief complaint history, focuses on the present symptoms and by itself is the history used in most ambulatory situations, involving acute symptoms. Past medical history includes general health status, infectious diseases and immunizations, adverse reactions to medications, and hospitalizations. It contains both active and inactive problems in a problem list. Personal history includes occupation, marital status, personal habits such as alcohol or smoking, financial status, and current living arrangements. Family history asks about significant health events in the lives of parents, siblings, and offspring, looking forpatterns of disease and common causes of death. A review of systems uses open-ended and closed-ended questions to probe for other symptoms or conditions, not found during the HPI; past, family, personal, and social histories; or a review of the health record. Ittends to start at the top of the body (head, eyes, ears, nose and throat) and move down, e.g., respiratory, cardiovascular, gastrointestinal, genitourinary tract, etc.

The chief complaint history What can I help you with today?Tell me more about your...........

Focused open ended questions: LOQQSAMLOCATION: where is it ? where does it move to?ONSET: when did it? How long do you have it?QUALITY: what does it feel like? Describe the feeling in your own word.QUANTITY: how frequently is it? How bad is it? (pain scale) How much interference daily routine?SETTING: how did it happen? When do you notice it? In which circumstances? What happened just before it started? ASS. SYMPTOMS: What other symptoms do you have? What else happended? How else do you

feel bad ordifferent around the time it happened?

MODIF.FACTORS: What makes it better? What worse? What have you tried for this? How did it work?OTHER QUEST: What do you think cause this problem? What medications are you currently taking?

SIT DOWN SIR

S Site or location of a sign/symptomI Intensity or severityT Type or natureD DurationO OnsetW With (other symptoms)N Annoyed or aggravated byS Spread or radiationI Incidence or frequencyR Relieved by

Closed ended questions

Summarization

So. You have had ......that started 3 days ago.

Closure

Is there anything we need to discuss today?

Each letter in the QuEST acronym is intended to represent a sequential step in the consultation process, namely:

• Quickly and accurately assess the patient. ASK about current complaint SCHOLAR ASK about MAC (medication, allergies, conditions)

•  Establish that the patient is an appropriate self-care candidate.NO severe or persistent/recurring symptom, NO self-treating to avoid medical care

•  Suggest appropriate self-care strategies medication or general care measures

•  Talk with the patient.about medication action, administration, adverse

effectsabout what to expect, about follow-up

The SCHOLAR •  Symptoms: What are the main and associated/related symptoms?•  Characteristics: What are the symptoms like?•  History: What has been done so far? Has this ever happened and what was successful?

•  Onset: When did this particular problem start? •  Location: Where is the problem? •  Aggravating factors: What makes it worse?•  Remitting factors: What makes it better?

The MAC •  Medications: prescription and nonprescription medications, natural products, and trade-name and generic products.•  Allergies: medication and other types of allergies.•  Conditions: other medical conditions.

TED

TELL „Tell me more about the feeling you get, when you take the blood pressure tablet“

EXPLAIN „Explain to me why you are worried about taking this new tablet“

DESCRIBE „You say, that your are feel out of sorts after taking your tablet, describe this feeling to me“

I am really sorry, how do you feel about that ?What effect is this having on you family ?

ICE

IDEAS Why do you think has this happened ? Have you any ideas about it yourself ?

CONCERNS What has been going through your mind ? Is there anything that is part. Worrying you ?

EXPECTATION What do you think might be the best approach ?

WHO Woman (pregnant (trimester) / breast (how often)) Elderly Child

SELF or someone else Appearance (ill looking, lethargic child)

REQUEST for product REQUEST for symptom help NEW prescription medicinePOM register

Have you used the medicine before?

YES: any further info needed?

NO: REQUEST for symptom helpHow has he come to request this product?

POM register

I am sure I can help.To help me give the best advice, though,I’d like a bit more information from you, so I need to ask a few questions. Is that OK?

QuEST SCHOLAR MAC

CD register, dispensing history

Hello.Thank you. I will quickly process the prescription.

Is this prescription for you?Is this a new prescription for you ?What has your doctor told you ?

Quickly SCHOLAR MACEstablish if SELF care candidateSuggest SELF care strategiesTalk about medicine, ADMINISTR: (eye drops, spray etc), adverse effects, FOLLOW UP (1 week)

The SCHOLAR •  Symptoms: main + assoc./related •  Characteristics: how are they•  History: Action taken? Ever happened and what was successful?•  Onset: When did it start? •  Location: Where is the problem? •  Aggravating factors: worse?•  Remitting factors: better?

The MAC •  Medications: also OTC, herbals•  Allergies: medicines/ other types •  Conditions:

“WHAT DID YOUR DOCTOR TELL YOU (INSERT MEDICATION NAME HERE) WAS BEING USED TO TREAT?”“HOW DID YOUR DOCTOR TELL YOU TO TAKE (INSERT MEDICATION NAME HERE)?” “WHAT TYPE OF RESPONSE DID YOUR DOCTOR TELL YOU TO EXPECT FROM (INSERT MEDICATION NAME HERE)?”

Check dose if appropriate, esp childCheck for interactionsCheck for allergies, duplications