Could You Please Rephrase the Question?

March 1, 2009

During a review of systems, I find it helpful and timesaving to ask the patient if he or she experiences symptoms that are out of the ordinary for the typical person. For example, instead of asking “Do you have fevers, chills, or night sweats?” I ask “Do you have fevers, chills, or night sweats more than the average person?” I find this approach yields more useful responses: they indicate whether the patient perceives the symptom as significant.

During a review of systems, I find it helpful and timesaving to ask the patient if he or she experiences symptoms that are out of the ordinary for the typical person. For example, instead of asking “Do you have fevers, chills, or night sweats?” I ask “Do you have fevers, chills, or night sweats more than the average person?” I find this approach yields more useful responses: they indicate whether the patient perceives the symptom as significant.

--Darin C. Fincher, PA-C
Columbia, Mo

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•This Practical Pointer suggests that clinicians ask patients if they have more fevers, chills, or night sweats than the average person. This is completely unnecessary. Also, how would a patient know what is average? The first part of the question, "Do you have fevers, chills, or night sweats?" is more than adequate; if they answer yes, then simply follow up with, "Is this is a new problem?" or "Are they happening more often or becoming more severe?"  

•What about facilities with EMRs?

•Yes, I find this tip helpful, especially with elderly as well as young adults.