How to take a focused history in 10 minutes

A good history gets you most of the way to a diagnosis. The hard part isn't knowing what to ask. It's asking it in a sensible order while a real person is talking to you. Here's a structure you can use every time.

1. Open well

Introduce yourself, confirm the patient's name and age, and ask an open question: "What's brought you in today?" Then stop talking. The first minute of uninterrupted story often contains the most useful clues.

2. Characterise the presenting complaint

For pain, SOCRATES keeps you complete:

• Site: where exactly?
• Onset: sudden or gradual, and what were they doing?
• Character: sharp, dull, crushing, burning?
• Radiation: does it go anywhere?
• Associated symptoms: sweating, nausea, breathlessness?
• Time course: constant or coming and going?
• Exacerbating and relieving factors
• Severity: 0–10, and how it affects daily life

For non-pain complaints, use the same idea: onset, duration, progression, triggers and impact.

3. Screen for red flags

Before you move on, ask the questions that would change your management today. For chest pain that might be exertional symptoms or pain radiating to the arm or jaw. For headache, sudden "worst ever" onset. Learn the red flags for the common presentations in your specialty.

4. Fill in the background

Past medical and surgical history, drug history and allergies, family history, and social history: smoking, alcohol, occupation, living situation. Keep it brief and targeted to the complaint.

5. Ideas, concerns, expectations

Ask what the patient thinks is going on and what worries them most. It builds trust, and it often brings up information you'd otherwise miss.

6. Summarise

Read back a two-line summary and ask, "Have I missed anything?" This catches errors and shows the patient you listened.

Practise it deliberately

Structure only becomes automatic with repetition. In Sushruta, patients hide some details unless you ask the right question, and the grading tells you which parts of the history you skipped. Try one encounter a day and watch your history score climb.