We all learn a "checklist" of history questions. This list has no prioritization and many students work at memorizing the list.
Clinicians actually do prioritize questions. Over the years I have identified 2 very useful questions. These questions help me in a wide variety of questions.
1. What do you do for fun?
This question has two purposes. First, it represents part of my screen for depression. Patients with anhedonia have very clear answers to this question – they do not have fun. Second, this question helps establish rapport with a new patient. You learn about their passions. In outpatient medicine, this knowledge can provide the first clue to deterioration. For example, I have had many patients who fish for fun. When I would ask when they had been fishing, and they had not gone recently, I knew that I must spend time understanding their change in status.
2. How well do you sleep?
Again this question gives clues for depression, but it also helps define the severity of the patient's complaints. Patients who sleep well generally are a lower severity of disease. This question helps with systolic dysfunction, obstructive sleep apnea and many other diseases. Often I find that this question opens new territory in my history taking.
So I offer these two questions to you to try in your history taking. Try them out and see if they are helpful.
Do you have any questions that you really like? Please share them with us!
{ 6 comments… read them below or add one }
who all lives at home?
Allows those without "traditional" arrangements to feel free to answer. Also sometimes gives surprising answers that give some insight into the life and relationhips of your patient.
I like the question "Why today?" for those who come to through the emergency department with subacute problems. It is always interesting to hear what the patient perceives to be as the last straw.
In similar tones as above, how are the symptoms limiting your life/work?
I like "What issue bothers you the most/ do you find most difficult/ is the most important to you?", "What do you hope that the treatment will achieve?" (cure, relieve pain, get me playing golf again) and the good old "Is there anything else you think I ought to know?"
Question 2 even more relevant in light of this recent study of a large sample of patients linking sleep disturbances (even subjective sleep quality) to increased risk of diabetes, obesity, and CAD
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2869.2011.00990.x/abstract
Love these. I will add them. I already ask, "Who lives at home with you?" (and I specifically ask about pets). My last two questions for new patients are, "Is there anything else I should know about you?" and "Is there anything else you'd like to know about me?"