Psychosocial history and impact on life


The MRCGP course organisers have written some quick reference tools to help you pass your MRCGP CSA exam and aid you in your consultation skills. We recommend using and adapting them into your daily consultations to improve your communication skills. All the articles and headings below are covered on the MRCGP course in detail and role-played in the group





  • It is essential to explore the psychological context of the patient symptoms. Do enquire about the psychological, social, occupational and, if required, the impact their symptoms have had on their life
    • Doctors often forget the impact the symptoms have upon the patient. Also many conditions such as stress or depression can manifest as physical symptoms
    • The psychosocial history is often linked to the patient idea, concerns and expectations. Appropriate ICE questioning will guide you to which areas of the psychosocial history to probe further
    • It offers background context to the consultation and makes it appear more natural and personal
    • It permits genuine rapport to develop in the doctor-patient relationship and allows you to empathise with their circumstance
    • It allows you to personalise your management plan specifically to the patient: ‘You mentioned how hard it was for you get out of bed because of your back pain. How do you feel about trying some light exercises in bed that I can show you just before you get up to ease your pain? Have you thought about some adaptations we can make to the house?’
  • Ask specifically about the psychological affect of the symptoms and how it has affected their life
    • It allows the patient to express the severity of their symptoms and how it has impacted their life, i.e. a builder complaining of chronic back pain who has lost his job as a result, now suffers from depression and causing financial and emotional strain on their relationship
  • Also enquire about the social history and family structures
    • Conditions often affect more than just the patient and can affect relatives and children 
    • Knowing who is at home allows you to consider support structures or resources that patient can use themselves. Or in other cases people at risk i.e. child protection, mental health etc
  • Ask about their occupational history and the impact their symptoms has had on their work
    • This can also reinforce the severity of their symptoms and the impact on their working lives
    • May put into context the impact of certain conditions upon their form of employment, i.e. colour blindness in a pilot, diabetic on insulin in a lorry driver

PSYCHOLOGICAL

How have your symptoms affected your life / impacted on your daily activities?
Have your symptoms made things more difficult?
How did that made you feel? Did that make you feel down?
How are you coping with all of this?


SOCIAL

Tell me more about yourself…like does anyone live with you at home?
How is your relationship with your partner?
How has it affected your home life? How are things at home?
Has your symptoms affected your relationship?
There are a lot of issues you have said, has it caused any problems at home?

OCCUPATIONAL
Are you working at the moment? What do you work as? What does that involve?
How do you find your work? Do you enjoy it?
How has your problem affected your ability to work?




By Nazmul Akunjee & Muhammed Akunjee

01.4.2014