Effects of disease

Relation to physiologic function

Progress

Associated sensations or mixtures of sensations

Factors which reduce pain

Circumstances which aggravate pain

Intensity

Quality

Character of pain

Temporal factors

Location of pain

Onset and Duration

— Isthe trouble acute or chronic?

— How long have you been ill?

— When were you last well?

— When did your symptoms first begin?

— Was the onset of the disease sudden or slow?

— Are there any known precipitating factors associated with the onset of illness?

Pain characteristics

— Where do you have pain?

— Would you show with your finger the place where it hurts you?

— Does the pain remain localized, or does it travel or radiate to some other region?

— Where is the pain? Outline the area with your finger.

— Does it spread from this area?

— How often does the pain occur?

— Is it continuous or intermittent?

— How long does it last?

— What time of day does it start?

— Does it come and go over short intervals?

— Is the pain sharp or dull?

— Is it really pain or is it discomfort?

— Does the pain appear suddenly and disappear quickly?

— Does the pain gradually increase in intensity and slowly subside?

— What does it feel like?

— Is it a burning pain, an aching pain?

— Is it steady or throbbing?

— How intense is the pain?

— Is it mild, moderate, or severe?

— Can you work with it or must you go to bed?

— What increases the intensity of the pain (coughing, sneezing, straining, stooping, jolting or shaking the head, lying down, sitting up)?

— What reduces the intensity of the pain (ice bag, hot water bottle, massage, finger pressure over temporal or other arteries, lying down, sitting up, sleeping, coffee, aspirin, or other medication)?

— What other symptoms are associated with the pain (anorexia, nausea, vomiting, distention, diarrhea, frequent urination, swelling of any part of the body)?

— Has the trouble developed rapidly or slowly?

— Have the symptoms become worse or better?

— Are they better at times and worse at others?

— Are the symptoms worse when you are standing, sitting or lying down?

— What effect does exercise produce?

— Does eating relieve the symptoms or aggravate them?

— Does sleep bring relief?

— Have you been treated for your ailment and what was the treatment?

— What was the opinion of other physicians?

— Have you become weak and lost weight?

— Did you ever have any fever, chills or sweats lately?

D. Past Illnesses:

— What diseases have you had in the past?

— What diseases did you have as a child?

— What childhood diseases did youhave?

— Have you ever had scarlet fever/measles/chickenpox/rubella/whooping cough/mumps?

— Have you ever had a venereal disease/malaria/diabetes mellitus?

— Have you ever had an infectious disease/tuberculosis/syphilis/heart attacks/fits?

— Have you been seriously ill before?

— Did you ever have a serious operation/injury/trauma?

— Have you been operated on?

— Have you ever been in hospital, if yes, for what reason?

— Are you allergic to any drugs?

— Have you had (have you) any unusual reaction to any drug, serum?

E. Personal History:

Martial Status:

— How many years have you been married?

— Is your wife (your husband) in good health?

— Are you happily married?

— Do you have difficulties with your wife (your husband)?

—Are sexual relations desired, enjoyed, satisfying for both marital partners?

— How many children do you have?

— How old are your children?

Habits:

— Do you smoke? How many cigarettes a day do you smoke?

— Have you a narcotic habit/an excessive drinking habit/some drug habit?

— How often do you take alcoholic drinks?

— How much alcohol do you drink daily?

— What amount of narcotics do you take daily?

Occupation:

— What was your first job?

— What was its nature and duration?

— What other kinds of job have you had?

— Why did you leave/retire?

— Are your present work and salary satisfactory?

— Do you consider your work too hard or too easy for you?

— What are the sanitary conditions at your work?

— Do you work under unfavourable hygienic conditions?

— Are you exposed to any occupational hazards?

— What industrial hazards are there in your enterprise?

— Do you work with lead (mercury, acids, alkalis, arsenic, ammonia, antimony, nickel, benzine, benzol, radioactive substances)?

F. Family History and familal tendency:

— Are your parents living or dead? What caused their death?

— At what age?

— Do you have brothers, sisters? Are they healthy?

— Is anyone in your family seriously ill? (Has anyone in your family been seriously ill?)

— Is there any history of tuberculosis (syphilis, cancer, diabetes mellitus, kidney disorders, hay fever, epilepsy, hypertension, alcoholism) in your family?

— Does ... run in your family?

— Is there anybody in your family who has similar complaints?

G. System Review: