Behavioral History Taking

I would actually love to talk about history taking in general, but the art of history taking is so vast, that I cannot even start. however, there are some technical approaches to behavioral history taking.

I personally believe that we should treat every single history taking as a BS station. You always need to be concerned with the patient's mental needs as well as their social needs. For some reason, some people assume that doctors only fix physical illness. 

I disagree. 

Health is defined as Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

therefore, it is my opinion that all health professionals will have to supply to the patients in terms of physical, mental and social well-being.

well. enough preaching. I know that you know this. 

here are some pointers to OSCE BS Stations.

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correct, proper GIEP

good morning, my name is ----, a --- year medical student. how may I address you?

hello Mr. / Miss ------. I am here to get some information (do not say 'history'. its a jargon). I may take some notes along the way. is that okay with you? (YES)

thank you very much!

first impression is pretty damn important. look confident, bright and clean.

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how to "show" empathy?

• firstly, the moment you enter the room, observe the patient for any pain or distress. address it, and ensure that he/she is comfortable.

Mr. / Miss ------, I notice you're clutching your stomache. are you in pain? (YES)

If at any point, you feel you cannot go on, please let me know. I will do whatever I can to make you feel comfortable. May I continue?

• LOOK at the patient, especially when s/he is talking about his/her PAIN.

(patient) - my stomach hurts. (presses on abdomen)

(you) - [looks at patient, whole body move forward, closes into the patient, looking at the abdomen.] where in your stomach does it hurt? here?  

• use of body language. 
• note-taking is not a good body language. 
• facing your whole body toward the patient shows that you are listening
• do not cross your legs / arms. it shows rejection
• put on your concerned face. I know that you think the SP's are faking it, but just pretend that you're talking to a real patient. if you can't even be concerned about real patients, you chose the wrong course, buddy.
• look at the patient's face.
• nod, reply, prompt to continue.

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how to address the patient's worries?

• in BS station, (and usually, other stations as well) patients will have specific worries.
• there are 2 components to this worries section. you need to address, and explore.
• addressing-

Do you have any worries that you would like to talk about?

actually i am afraid i might have cancer (etc etc...)

• exploring

what makes you think so? do you have any reason that you think that way? 

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how not to be condescending

patients will know if you think you know better then them. 

be humble. 

if they say anything to prove you wrong, you should listen to their justification before saying anything at all.

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how to "touch" patients

sometimes, sufficient body language can be used when the patient is in a great extent of emotional pain.

this comes through practice. practice on your friends... if they get annoyed, you are doing it wrong. they will actually thank you if you do it right.

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how to address various different feelings


sometimes, patients get angry, sad, confused.... whatever. 
general approach to these kinds of exhibits of feelings are firstly addressing them.


after you address them, deal with their feelings / problems before you continue on.


there is no difficult patients - only difficult situations.
most patients have a very good reason to be "difficult". listen to them. 
listen before you make any judgement.
listen before you make any comments
listen before you suggest anything
listen before he/she even talk. - there are unspoken clues as well.
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a guaranteed high-score in BS station is obtained most easily by genuine empathy and care. i know not everyone can do this, but believe it or not, it comes with practice. if you're a person that doesn't give a damn, start doing so. it will be your job. 

start caring for your family, friends and strangers. 

think what is bothering them. 

think about their pain. 

talk to people whom are upset.

all these will improve your history taking skills.