Initiating consultation
Greet, confirm pt details. Introduce self, purpose of interview, gain consent
PC/HPC
Symptoms
Red Flags
1. Blood in stools.
2. Weight loss
3. Change in bowel habits
4. Loss of appetite
5. Tenesmus (feeling of
incomplete defecation)
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Pain: SQITAS/SOCRATES
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Constipation: Frequency, size, colour, consistency, duration, pain, straining, relieving and aggravating
factors, vomiting (signifies obstruction), bloating
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Diarrhoea: Frequency, colour, consistency, duration, intermittent or constant relieving and aggravating
factors, mucus (IBD)
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Other Stool changes: steatorrhoea , melena
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Change in diet: fluid intake, lack of fibre can cause constipation, poorly cooked foods can cause
diarrhoea
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Red flags
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Impact on life
PMHx
Hernias, surgery, cancer, colonoscopy
DHx
Antibiotics: can cause diarrhoea (by selecting for diarrhoea causing bacteria)
Laxatives, Opiates, Iron tablets
FHx
Hx of IBD, Colorectal cancer – ask generally and make it specific to GI
SHx
Travel! smoking, alcohol, drugs, occupation, home, exercise
ICE
Make sure you get it in there!
Systems Review. Summarise, does the pt have any questions? Thank the patient
Tips
Frequency: It is important know how much the patient is going to the toilet to class it as constipation or not, but what is most important is if this
amount has changed relative to their normal amount “How often are you passing stool? *response* And is that more or less than normal for you?”
Patient’s definition: What does the patient mean when they say “diarrhoea” or “constipation”? What they think it is classified as could be very
different to your interpretation. Get clarification
SOCRATES:
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Site - Where is the pain? Or the maximal site of the pain.
Onset - When did the pain start, and was it sudden or gradual? Include also whether if it is progressive or regressive.
Character - What is the pain like? An ache? Stabbing?
Radiation - Does the pain radiate anywhere? (See also Radiation.)
Associations - Any other signs or symptoms associated with the pain?
Time course - Does the pain follow any pattern?
Exacerbating/Relieving factors - Does anything change the pain?
Severity - How bad is the pain?
SQITAS
Site Quality Intensity Timeliness Aggravating/Alleviating factors Symptoms(associated)
DRUGS – this can be a good way to tease out a Past Medical History
Dr prescribed
Recreational (but leave this for Social History)
User prescribed
Gynaecological
Sensitivities