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“Narinder Kaur has been referred to gastroenterology outpatients for further investigation of abdominal discomfort.  Please take a full history and discuss your findings with the examiners.”

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The first key feature is that the doctor introduces herself and checks the patient’s name. She allows the patient to give their information without interrupting. She allows him to speak. Often doctors, through bad habits, because we work out the diagnosis often very quickly in our heads, it is tempting to just go straight for the questions that confirm the presumed diagnosis. However, not only will you miss other features of a history that may indicate an alternative, it does not allow the patient to convey all that they want to and they may not give all the best information.

Remember to start with open questions before going into closed questions, as time goes on:

The doctor asks what the patient’s concerns are, as this may be different to yours. The doctor also asks the ‘get out of jail free’ question “is there anything else I have not asked’ – if you have missed something, then this is method to get some of that information.

She also signposts about what she is going to ask, for example ‘just some specific questions’ so the quick, short, sharp questions do not make the patient uncomfortable.

Asking patients about illicit drugs can be tricky and some people may be offended. Note how the doctor signposts it by normalising it ‘I have to ask everyone’ rather than appearing to think someone looks like they take illegal drugs (this also works for unprotected intercourse).

[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Specimen case presentation”][vc_column_text]”Mrs Nurinder Kaur is a 45-­year old woman who presents with tiredness, general malaise, diarrhoea, bloating and some weight loss. She has a family history of diabetes. There are a number of diagnoses at this stage, including a gastrointestinal malignancy, and also Coeliac disease.

I would like to complete a clinical examination, and carry out repeat baseline blood tests and include thyroid function, bone profile and a tissue transglutaminase and total IgA levels. If these are positive, I will arrange an OGD and colonoscopy.”

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