WHO

Woman (pregnant (trimester) / breast (how often))

SELF or someone else

REQUEST for product

POM register

Elderly

Child

Appearance (ill looking, lethargic child)

REQUEST for symptom help

POM register

Have you used the medicine before? I am sure I can help.To help me give
the best advice, though,Id like a bit
YES: any further info needed?
more information from you, so I need
to ask a few questions. Is that OK?
NO: REQUEST for symptom help
How has he come to request this
SYMPTOMS: Could you tell me
product?
what sort of trouble you have
had........?
Duration !....For how long
How and when it began,
Timing of symptoms
How it has progressed
What have you tried so far ?
Any other symptoms or anything
different from usual
Decision: REFERRAL Danger,
Duration, Incomplete info
TREATMENT: effective and safe
(medical history and medicine use)
(age restriction)
OUTCOME: improvement within
usually 1 week, otherwise DOCTOR

NEW prescription medicine

CD register, dispensing history
Hello.
Thank you. I will quickly process the
prescription.
Is this prescription for you?
Is this a new prescription for you ?
What has your doctor told you ?

Could you just tell me what sort of trouble you get with your piles?
Im not sure I quite understand when you say . . . , or Im not quite clear what you meant by . . . .
Id just like to make sure Ive got it right. You tell me youve had this problem since . . .
Also ask then some more direct questions to exclude danger symptoms
Other questions could include
what treatments have you tried so far this time? What sort of treatment were you hoping for today?
What other medications are you taking at present? Do you have any allergies?
REFERRAL:Long duration of symptoms
Recurring or worsening problems
Severe pain
Failed medication (one or more appropriate medicines used already, without improvement)
Suspected adverse drug reactions (to prescription or OTC medicine)
Danger symptoms.
For accidents and injuries:_ The person is, or has been, unconscious.There is a suspected broken bone or dislocation.The person is
experiencing severe chest pain or is having trouble breathing.The person is experiencing severe stomach ache that cannot be treated by OTC
remedies.There is severe bleeding from any part of the body.

e.g. History taking is particularly important when assessing skin disease. For example the use of a topical
corticosteroid inappropriately on infected or infested skin may substantially change the appearance; allergy to
ingredients such as local anaesthetics may produce a problem in addition to the original complaint.The attacks of
heartburn that occur after going to bed or on stooping or bending down are indeed likely to be due to reflux,
whereas those that happen during exertion such as exercise or heavy work may not be. In recurrent mouth ulcers,
for example, do the current ulcers resemble the previous ones, was the doctor or dentist seen on previous
occasions, was any treatment prescribed or OTC medicine purchased and, if so, did it work?

A complete medical history

consist of five components: history of present illness (HPI), past medical history, family history,
personal/social history, and a review of systems.
The HPI, also known as a chief complaint history, focuses on the present symptoms and by itself
is the history used in most ambulatory situations, involving acute symptoms.
Past medical history includes general health status, infectious diseases and immunizations,
adverse reactions to medications, and hospitalizations. It contains both active and inactive
problems in a problem list.
Personal history includes occupation, marital status, personal habits such as alcohol or smoking,
financial status, and current living arrangements.
Family history asks about significant health events in the lives of parents, siblings, and offspring,
looking for
patterns of disease and common causes of death.
A review of systems uses open-ended and closed-ended questions to probe for other symptoms
or conditions, not found during the HPI; past, family, personal, and social histories; or a review of
the health record. It
tends to start at the top of the body (head, eyes, ears, nose and throat) and move down, e.g.,
respiratory, cardiovascular, gastrointestinal, genitourinary tract, etc.
The chief complaint history
What can I help you with today?
Tell me more about your...........
Focused open ended questions: LOQQSAM
LOCATION:
where is it ? where does it move to?
ONSET:
when did it? How long do you have it?
QUALITY:
what does it feel like? Describe the feeling in your own word.
QUANTITY:
how frequently is it? How bad is it? (pain scale) How much interference daily
routine?
SETTING:
how did it happen? When do you notice it? In which circumstances? What
happened just
before it started?

ASS. SYMPTOMS:
feel bad or
MODIF.FACTORS:
work?
OTHER QUEST:
taking?

What other symptoms do you have? What else happended? How else do you
different around the time it happened?
What makes it better? What worse? What have you tried for this? How did it
What do you think cause this problem? What medications are you currently

SIT DOWN SIR

S
I
T
D
O
W
N
S
I
R

Site or location of a sign/symptom

Intensity or severity
Type or nature
Duration
Onset
With (other symptoms)
Annoyed or aggravated by
Spread or radiation
Incidence or frequency
Relieved by

Closed ended questions

Summarization

So. You have had ......that started 3 days ago.

Closure
Is there anything we need to discuss today?

Each letter in the QuEST acronym is intended to represent a sequential step in the consultation
process, namely:
Quickly
Establish
Suggest
Talk

and accurately assess the patient. ASK about current complaint SCHOLAR
ASK about MAC (medication, allergies, conditions)
that the patient is an appropriate self-care candidate.
NO severe or persistent/recurring symptom,
NO self-treating to avoid medical care
appropriate self-care strategies
medication or general care measures
with the patient.
about medication action, administration, adverse

effects
about what to expect, about follow-up
The SCHOLAR
Symptoms:
Characteristics:
History:

What are the main and associated/related symptoms?

What are the symptoms like?
What has been done so far? Has this ever happened and what was

successful?
Onset:
When did this particular problem start?
Location:
Where is the problem?
Aggravating factors:
What makes it worse?
Remitting factors:
What makes it better?
The MAC
Medications:
name and generic
Allergies:
Conditions:

prescription and nonprescription medications, natural products, and tradeproducts.

medication and other types of allergies.
other medical conditions.

TED
TELL

Tell me more about the feeling you get, when you take the blood pressure tablet

EXPLAIN

Explain to me why you are worried about taking this new tablet

DESCRIBE
You say, that your are feel out of sorts after taking your tablet, describe this
feeling to me
I am really sorry, how do you feel about that ?
What effect is this having on you family ?
ICE
IDEAS

Why do you think has this happened ? Have you any ideas about it yourself ?

CONCERNS
you ?
EXPECTATION

WHO

What has been going through your mind ? Is there anything that is part. Worrying
What do you think might be the best approach ?

Woman (pregnant (trimester) / breast (how often))

SELF or someone else

REQUEST for product

POM register

Elderly

Child

Appearance (ill looking, lethargic child)

REQUEST for symptom help

POM register

Have you used the medicine before? I am sure I can help.To help me give
the best advice, though,Id like a bit
YES: any further info needed?
more information from you, so I need
to ask a few questions. Is that OK?
NO: REQUEST for symptom help
How has he come to request this
QuEST SCHOLAR MAC
product?

NEW prescription medicine

CD register, dispensing history
Hello.
Thank you. I will quickly process the
prescription.
Is this prescription for you?
Is this a new prescription for you ?
What has your doctor told you ?

Quickly SCHOLAR MAC

Establish if SELF care candidate
Suggest SELF care strategies
Talk about medicine, ADMINISTR:
(eye drops, spray etc), adverse
effects, FOLLOW UP (1 week)
The SCHOLAR
Symptoms: main +
assoc./related
Characteristics: how are
they
History:
Action taken?
Ever happened and what was
successful?
Onset: When did it start?
Location: Where is the
problem?
Aggravating factors:
worse?
Remitting factors: better?
The MAC
Medications: also OTC,
herbals
Allergies: medicines/ other
types
Conditions:

WHAT DID YOUR DOCTOR TELL YOU

(INSERT MEDICATION NAME HERE) WAS
BEING USED TO TREAT?
HOW DID YOUR DOCTOR TELL YOU TO
TAKE (INSERT MEDICATION NAME HERE)?
WHAT TYPE OF RESPONSE DID YOUR
DOCTOR TELL YOU TO EXPECT FROM
(INSERT MEDICATION NAME HERE)?

Check dose if appropriate, esp child

Check for interactions
Check for allergies, duplications