Chapter 1:	The Patient Interview
Page 3 0f 3

Many of the questions posed during the initial interview involve the patient’s medical history, including the following:

• Personal demographic information, including: patient’s name, date of birth, nationality, occupation, marital status, religious affiliation, and referral source.
• Patient’s answers and brief self-descriptions of physical condition to questions posed during the interview, including:
• Chief complaint: What made the patient decide to seek medical assistance--in their own words, and your comments.
• Present illness: Record the patient’s and your description of current symptoms, when they first occurred and whether they have gotten worse or better with time. Be sure to include a description of the location, frequency and duration of occurrence, severity of pain, and identification of the factors that contribute to an increase or diminution of the symptoms.

RCPs should take special note of problems involving the patient’s cardiopulmonary system, asking them about the following:

• Cough: Does the patient have a cough? If so, so they describe it as severe, moderate, or slight? If you observe the cough, record your evaluation. Ask them for how long they’ve had the cough, when is it the worst, the least. Document the cough’s characteristics: hacking, dry, productive of mucous or phlegm, etc. If they cough up blood, determine the exact amount, color and consistency, of the blood.



• If the patient has Hemoptysis (expectoration or coughing up of blood or bloody sputum from the lungs, this can be significant in the diagnosis. However, you need to be aware not to confuse Hematemesis (vomiting of blood) with hemoptoysis.



• Dyspnea: Does the patient ever feel short of breath, during rest or physical activity. Ask them to describe the degree of shortness of breath on an imaginary scale of one to ten.



• Wheezing: This involves emission of a whistling-like sound resulting from narrowing of the lumen of a respiratory passageway. Ask and observe if the patient is wheezing. If so, inquire as to when it appears to occur most and what seems to provoke it.



• Chest Pain: Do they experience it? If so, ask where it’s located, is the onset sudden, does breathing deeply breathing or coughing aggravate it?



• Locomotor System: Does the patient ever experience pain when using their muscles or moving their joints? Are they currently experiencing such pain?



• Nervous System: Ask the patients if they are currently experiencing any headaches, muscle weakness, dizzy feelings, feeling faint, experiencing any seizures or convulsions, tremors, vertigo, diplopia, paralysis, paresis, or ataxia.



• Psychiatric Problems: Ask if they are currently feeling particularly nervous, stressed, episodes of depression, having trouble sleeping or nightmares, or suffering any memory loss.



• Anorexia and Weight Loss: Ask if the patient has recently experienced a loss of appetite, with an attendant loss of weight. This can be very relevant to making a proper diagnosis of respiratory problems.



• Night Sweats: Ask if the patient is experiencing excessive perspiration during sleep at night. If so, ask specific questions regarding the location and characteristics of the perspiration, including odor.



• Digestive System: Ask if the patient is having trouble digesting their meals. Are they experiencing nausea, or vomiting? Does their digestive system involve excess gas or belching, excessive stomach sounds? Do they have difficulty swallowing, and do they experience dark or bloody stools?



• Genitourinary System: Ask if the patients are experiencing any pain or difficulty urinating, incontinence, had any renal stones, or urinary infections.



• Endocrine System: Ask if the patient is diabetic, has intolerance to heat or cold, or has recently experienced any change of voice.

Past Medical History, ask the patient for information regarding:

• Past Illnesses, including: recurrent episodes of pulmonary infections, infectious diseases, infantile eczema, atopic dermatitis, accidents, allergic rhinitis, or co-existing conditions such as diabetes, hypertension, thyroid, or other glandular disorders should be noted. Other illnesses to inquire about: rheumatic fever, diabetes, pneumonia, tuberculosis, arthritis, jaundice, kidney or heart trouble, ulcer, phlebitis, anemia asthma, hay fever, hives, cancer, measles, adenoviral infections, or pertussis in childhood which may predispose the individual to bronchiectasis. Is the patient taking any medications, such as: antihypertensives, steroids, bronchodilators, heart medications, or diuretics.



• Past Hospitalizations: you should also document any past hospitalizations for infection or surgery (especially chest procedures which may be the cause of cardiorespiratory insufficiency). Also inquire about dental extractions, upper respiratory tract surgery, or aspiration of foreign bodies because they may cause pulmonary abscesses.



• Allergies: finally you should ask patients if they have any allergies, for example: to animals, flowers, perfumes, dust, drugs and foods which may trigger allergic reactions.

Family History: You should inquire about the patient’s familial disease history (particularly hereditary diseases, such as cystic fibrosis and asthma), and illnesses such as TB. You should also determine the patient’s marital status, and the health status of a spouse.

Social and Environmental History: Is the information regarding the patient’s background and living habits that may be associated with the development of illness. Areas where the patient has worked, lived, or traveled should be listed, with the amount of time spent in each area. In addition, your interview should cover the following:

• Patient’s level of education and general economic circumstances
• Military service experience
• Occupational history: Should include the duration of each job. It is important to note exposure to coal dust, asbestos, cloth or wood fibers, or toxic gases. Also, be sure to inquire as the level of stress they feel on the job.
• Activities: Social, religious, hobbies and habits. Do they engage in any hazardous activities? Ask them to describe their general diet, sleeping patterns. Are they having any problems with insomnia? Is adding pillows for sleeping or sleeping in a recliner common? Do they exercise, use tobacco, alcohol, coffee, special drugs (laxatives, sedatives, psychotropics)?