The Social History and Long Case Histories
I recently was chatting to some medical students about the importance of the Social History in their upcoming Long Case Examinations. We agreed that the Social History was important both in the exam and in clinical practice but that it can be hard remember to ask everything required.
For example, it’s easy to forget to take the ‘driving’ history in a patient with a seizure disorder when you haven’t had the experience of seeing many patients with this problem. As a result the Template outlined below might be helpful in order not to miss crucial aspects of this part of the history.
Long case examiners are always interested in the student’s ability to link the patient’s symptoms and diagnosis to their Activities of Daily Living (ADLs) and home life.
With the pressure of the examination I found it useful to take the social history early using the ‘Social Blitz’ template (below).
I tried to tie the Social History in with the History of Presenting Complaint and Past Medical History as much as possible.
The Social Blitz Template
- Bonking (the sexual history not always required but is important in male diabetics for example)
- Cigarettes (number of pack years and previous and current attempts to stop – stage of contemplation)
- Driving (especially for cardiac and neurological disease)
- Finances (Social Supports and Benefits) and Family Support / Carers
- GHB (and other Illicit Drugs)
- Immunisations (e.g. Influenza, MMR, Tetanus and Pneumonia Vaccines)
- Journeys (especially overseas and recent travel)
- Kangaroos (Pets)
- LMP – (12-60F pregnant until proven otherwise)
My approach for getting through the long case examination was to write the above Social History template down in the exam and then fill in the details as the issues were discussed with patient…
Of course, in the Emergency Department a relevant Social History is an essential (albeit truncated) part of planning the patient’s management and discharge planning.
NEJM – Social History