History Taking: SOCRATES
Hello fellow medics :)
SOCRATES is a mnemonic for remembering the questions to ask after a patient presents with a ‘complaint’. Although traditionally used for “pain”, it can be adapted to suit any history (give or take!).
Remember SOCRATES/or other mnemonics are there as a prompt, and therefore it is important to have flow and listening skills.
Continue reading below to see SOCRATES broken down with some specific questions which may help.
Site: “Can you tell me in your own words where the pain is?”
“Can you point to where the pain is?”
Non pain history: “Tell me more about how you are feeling”
“Where do you feel this tightness?”
Onset: “When did the pain first start?”
“How long have you had this pain?”
“What were you doing when the (pain/symptom) first came on?”
Non pain history: “When did this shortness of breath come on?”
“When did you start to feel low?”
Character: “Describe the pain to me” (you may need to prompt the patient if they cannot find the words) “is it a stabbing pain, a dull ache, does it come and go?”
Non pain history: “Describe the colour/consistency of the stool”
“How would you describe the lump- hard, soft?”
Radiation: “Does the pain travel anywhere?”
“Is the pain just in the one place?”
Non pain history: NA
Associated symptoms: “Is there anything else you have noticed with this pain?” (this will be based on the system involved i.e. with chest pain: “Do you have shortness of breath?” etc)
Learn the associated symptoms with each presenting complaint - luckily there are lots of overlap.
Timing: “When does the pain come on?”
“Does it come and go depending on what you eat?”
“Is the pain constant?”
Non pain history: “When do you feel sick? Any specific time of the day?”
Exacerbating/Relieving factors: “What makes the pain better?” (ie movement, medications)
“What makes the pain worse?”
Non pain history: “What makes the groin lump bigger?”
“How do you manage the stiffness in your joints?”
Severity: “can you tell me how bad the pain is on a scale of 1-10?”
“What impact does this pain have on your daily activities?”
“What is this pain stopping you from doing?” (referring to the impact on ADLS- Activities of Daily Living)
Non pain history: “How far can you walk before being breathless?”
“How is your mood impacting your sleep/ability to function?”
Flow is essential in taking a history, and so a mnemonic is ideal for when your flow disappears due to anxiety of the OSCE station…and you need something to put you back on track.
Any further questions, please don’t hesitate to email/DM me- I am here to help and guide :)
Happy revising :)