New Patient Alert: Initial Questioning

#FamilyMedicine

What is Initial Questioning?

In the Family Medicine clinic, patients are always switching between doctors and new patients come in daily. Initial questioning, or medical history taking, is a process of understanding the patient's medical background. I learned the most important consideration in this process is asking open-ended questions which let patients steer the direction. Many times, new patients may be reluctant to share or just might simply forget to include key details. The goal of initial questioning is to understand why the patient is in the clinic today, or the Chief Complaint, as well as the general overview of previous health concerns, experiences, or thoughts.

The Process

Here's a very basic overview of the kinds and orders of questioning that a physician may take when performing an initial questioning with a new patient. Doctors are not just looking for answers to their questions, but also trying to lead patients to talk more deeply regarding their experiences.

1. Ask about the specific issue (Chief Complaint)

2. Ask about health history broadly

4. Ask about the health history of the present problem

5. Focus on the most severe illness or pain present

6. Systemic exploration – review all systems by asking about pain or discomfort

7. Past medical history, examine previous

8. Social history of the patient

a. What do they do regularly (Occupation)?

b. Drinking, smoking?

c. Passive/active relaxation? (Essentially, "watch TV" to relax or practice wellness routines)

d. Hobbies and activities?

9. Family History

a. Parents/Grandparents

b. How close and how connected

c. Siblings/children/stepchildren

d. Married, unmarried, first time?

e. All connections of the social outlook of the patient

10. Allergies or other Concerns

Other Considerations

It's important to remember the context of this initial questioning in a family medicine clinic. Patients are not in immediate distress and usually present for annual check-ups and preventative care. Family History can be significant in this context because it may provide insight relating to patient emotional trauma or future patient complications.

The physician is always looking to dive deeper into specific circumstances that the patient may not even consider as important. My mentor described it as a scavenger hunt: hear for words or phrases that were quickly passed and make sure to address them. Initial questioning isn't just about knowing the patient medically, but also connecting with their personality, understanding their comfort, and finding common ground for genuine interaction.