00:05
In terms of making an assessment, you want to ask your patient about pain symptoms. You want to
know if they have experienced the headache, back or joint pain, or any extremity pain. You
also want to ask about stomach issues or GI symptoms like nausea and vomiting and diarrhea.
00:21
They may also pass gas or have some bloating or abdominal pain and you want to ask about
cardiopulmonary symptoms, things like chest pain, shortness of breath, or heart palpitations
and dizziness. Then you want to also ask about reproductive problems so whether or not there
is any pain during intercourse or abnormal menstrual cycle especially with pain during it, any
burning during intercourse or passing urine and this is the summary of groups of systems that
you want to make sure you ask your patient about during the assessment. Neurological symptoms
can include fainting, pseudoseizures, amnesia, muscle weakness, dysphagia, vision changes,
gait instability, difficulty urinating, deafness, hoarseness and aphonia. So let’s go back to this
case example. “Middle-aged woman who comes to her primary care doctor multiple times over the
course of only 1 month with numerous vague complaints. Okay, she said she has pain in every
joint, nausea, sexual dysfunction and a tremor but again you can’t actually find any physical
problems with her. She’s anxious and upset when you ask her if she has been stressed out lately
and maybe mention referring to a psychiatrist.” So what do you suspect? She may be presenting
with a somatization disorder. So when taking a patient’s history, establishing trust is extremely
key. A lot of people who have seen multiple clinicians already and trust may be an issue. They
may feel embarrassed or humiliated so it’s really important to focus on a therapeutic alliance.
02:00
Explore with your patient the medical and psychological etiology at the same time and this will
help the patient feel a little bit more confident that you’re believing them and that you’re not
going to discount their symptoms or not take them seriously. So pay attention to physical symptoms
as well as emotions, ask the patient if there has been any stressful events lately, assess their
physical problems and ask what makes it worse, what makes it better. So, don’t just discount
their symptoms because you think maybe something psychiatric is happening. The patient takes
their physical symptoms very seriously. They may even feel like they’re dying or they’re going
to lose their organ function. So listen very carefully and take a thorough history including
asking about their family history and social history. You want to know if other people have
been affected and offer your patient reassurance. Make sure to ask them about medications
that they’re taking including over-the-counter medications and of course screen them for substance
abuse because this can be comorbid. It’s important to ask whether or not the patient has
experienced physical or sexual abuse whether the patient feels safe in their current relationship,
or whether or not they feel threatened in any way.