What kinds of questions might someone ask a patient to get the information about their chief complaint?

SAMPLE, a mnemonic or memory device, is used to gather essential patient history information to diagnose the patient's complaint and make treatment decisions. Like OPQRST, asking these SAMPLE questions is the start of a conversation between you, the investigator, and the patient, your research subject:

1. Signs and symptoms 2. Allergies 3. Medications 4. Pertinent medical history 5. Last ins and outs

6. Events

SAMPLE questions are asked of any patient. Though if a patient has airway, breathing or circulatory life threats, gathering a patient history is secondary to treating those time-sensitive, life-threatening conditions, like removing an airway obstruction or performing chest compressions.

The results of SAMPLE can help identify the cause of a medical condition, like anaphylaxis secondary to ingestion of an allergen. The questions can also help diagnose a reason for traumatic injury. For example, alcohol consumption might have caused a fall and fracture, as well as potentially predicting respiratory depression and airway compromise.

Here are some tips on how to best approach using SAMPLE history during the secondary assessment.

Signs and symptoms

Signs are what you can measure, such as heart rate or respiratory rate. Signs are also what you can hear or see. You can auscultate wheezing or see a bruise. Symptoms are what the patient complains about. Symptoms are the patient's subjective description of their illness or injury.

Robotically asking a patient, "What are your signs and symptoms?" will either result in a blank stare or a long narrative of a complex and confusing medical history. If you haven't asked or been told already, ask the patient or their caregiver, "Why did you call for an ambulance?"

Sometimes the reason for EMS is self-evident, like a deformed extremity, a patient clutching their chest or audible wheezing. Other times you make need to probe to determine the nature of the patient's complaint. Use the patient's answer to ask follow-up questions about their symptoms associated with or relevant to the problem.

For patients with a pain complaint, use the OPQRST mnemonic to learn more. OPQRST, like SAMPLE, continues the conversation between the investigator and the research subject. Delve even deeper into the patient's chief complaint to identify the presence of associated signs or absence of pertinent negatives.

Allergies

Asking, "Are you allergic to any medications?" limits the patient's response to just medications. Follow-up with, "Do you have any other allergies we should know about?" Or ask a broader question, "Do you have any allergies?" or "Are you allergic to any foods, medications or insects?"

Continue the investigation by asking about the patient's reaction to an allergen. For example, do they have a local or systemic reaction?

Medications

Asking the patient "What medications do you take?" is a starting point. Ask the patient if they are taking those medications as prescribed. Also ask the patient if they use any over-the-counter medications, supplements or homeopathic formulations. If you want to know more about medications, which you should, don't hesitate to ask the patient what conditions they take those medications for or use a drug guide app on your smartphone.

Pertinent medical history

Because of the detective work you have already done, you may know from your allergy and medication questions many of the patient's medical conditions. Ask "Do you have any medical conditions or history we should know about?"

Instead of past medical history focus your inquiry on pertinent medical history. A broken ankle suffered as a child isn't pertinent for a geriatric patient with a fever, confusion and hypotension, but a recent urinary tract infection, though, is very pertinent. Use follow-up questions about outcomes of previous illness or injury to gather additional information. 

Last ins and outs

Many caregivers narrowly ask their patient about last oral intake, with a focus on food eaten at the patient's most recent meal. Cast a wider net and ask "Have you been eating and drinking normally?" If yes, ask "What is normal for you?" or if no, ask "What has kept you from eating normally and for how long?"

For patients with abdominal pain complaints, asking about their last outs – urination and bowel movements – is relevant and appropriate. Frequency, color, smell and consistency may also provide useful information for patients who have a fever, gastrointestinal or genitourinary pain complaint or a recent history of abdominal or pelvic trauma.

If you haven't already, this is another chance to ask the patient about recreational or illegal drug use. Marijuana legalization is in a growing number of states, widespread availability of synthetic marijuana is being sold as bath salts, and the opioid epidemic is making drug intoxication a likely cause of altered level of consciousness and behavioral complaints.

Events

The final questions are an opportunity for the patient to give you a frame-by-frame description of what happened leading up to their illness or injury. For a traumatic injury, better understanding the mechanism of injury might help identify additional injuries or even risks for repeating the injury.

Use the information you have gathered with SAMPLE, along with vital signs and physical exam findings, to make treatment decisions. Remember, SAMPLE findings can confirm indications for a treatment as well as contraindications, like a medication allergy, to a prehospital intervention.

Finally, don't limit the patient history taking with SAMPLE to the size of the form fields in the electronic patient care report. As a clinician, investigate the patient's complaint with the goal of making a diagnosis (yes, EMTs diagnose patients) or to assist other clinicians in making a definitive diagnosis.

What are your SAMPLE success tips or questions? Share them in the comments.

This article was originally posted Jan. 25, 2017. It has been updated.

Taking a history from a patient is a skill necessary for examinations and afterwards as a practicing doctor, no matter which area you specialise in. It tests both your communication skills as well as your knowledge about what to ask. Specific questions vary depending on what type of history you are taking but if you follow the general framework below you should gain good marks in these stations. This is also a good way to present your history.

In practice you may sometimes need to gather a collateral history from a relative, friend or carer. This may be with a child or an adult with impaired mental state.

Procedure Steps

Step 01

Introduce yourself, identify your patient and gain consent to speak with them. Should you wish to take notes as you proceed, ask the patients permission to do so.

Step 02 - Presenting Complaint (PC)

This is what the patient tells you is wrong, for example: chest pain.

Step 03 - History of Presenting Complaint (HPC)

Gain as much information you can about the specific complaint.

Sticking with chest pain as an example you should ask:

• Site: Where exactly is the pain?
• Onset: When did it start, was it constant/intermittent, gradual/ sudden?
• Character: What is the pain like e.g. sharp, burning, tight?
• Radiation: Does it radiate/move anywhere?
• Associations: Is there anything else associated with the pain, e.g. sweating, vomiting.
• Time course: Does it follow any time pattern, how long did it last?
• Exacerbating / relieving factors: Does anything make it better or worse?
• Severity: How severe is the pain, consider using the 1-10 scale?

The SOCRATES acronym can be used for any type of pain history.

Step 04 - Past Medical History (PMH)

Gather information about a patients other medical problems (if any).

Step 05 - Drug History (DH)

Find out what medications the patient is taking, including dosage and how often they are taking them, for example: once-a-day, twice-a-day, etc.

At this point it is a good idea to find out if the patient has any allergies.

Step 06 - Family History (FH)

Gather some information about the patients family history, e.g diabetes or cardiac history. Find out if there are any genetic conditions within the family, for example: polycystic kidney disease.

Step 07 - Social History (SH)

This is the opportunity to find out a bit more about the patient’s background. Remember to ask about smoking and alcohol. Depending on the PC it may also be pertinent to find out whether the patient drives, e.g. following an MI patient cannot drive for one month. You should also ask the patient if they use any illegal substances, for example: cannabis, cocaine, etc.

Also find out who lives with the patient. You may find that they are the carer for an elderly parent or a child and your duty would be to ensure that they are not neglected should your patient be admitted/remain in hospital.

Step 08 - Review of Systems (ROS)

Gather a short amount of information regarding the other systems in the body that are not covered in your HPC.

The above example involves the CVS so you would focus on the others.

These are the main systems you should cover:

• CVS
• Respiratory
• GI
• Neurology
• Genitourinary/renal
• Musculoskeletal
• Psychiatry

Please note these are the main areas, however some courses will also teach the addition of other systems such as ENT/ophthalmology.

Step 09 - Summary of History

Complete your history by reviewing what the patient has told you. Repeat back the important points so that the patient can correct you if there are any misunderstandings or errors.

You should also address what the patient thinks is wrong with them and what they are expecting/hoping for from the consultation. A useful acronym for this is ICE [I]deas, [C]oncerns and [E]xpectations.

Step 10 - Patient Questions / Feedback

During or after taking their history, the patient may have questions that they want to ask you. It is very important that you don’t give them any false information. As such, unless you are absolutely sure of the answer it is best to say that you will ask your seniors about this or that you will go away and get them more information (e.g. leaflets) about what they are asking. These questions aren’t necessarily there to test your knowledge, just that you won’t try and 'blag it'.

Step 11

When you are happy that you have all of the information you require, and the patient has asked any questions that they may have, you must thank them for their time and say that one of the doctors looking after them will be coming to see them soon.

This guide is designed for students and doctors. If you are applying for medical school and would like more information on the UCAT please check out our complete guide and our guide on how to practice for your exam. We've also prepared a UCAT Practice Test to help you prepare for the exam.