Back pain 2.6 BACK PAIN 1. Introduction and approach to patient No elements 1 2 3 4 All elements 5 3 4 All elements 5 3 4 All elements 5 2. Main presenting symptoms No elements 1 2 2 3. Relevant supporting information No elements 1 2 4. Patient’s perception and understanding No elements 1 2 3 4 All elements 5 2 3 4 All elements 5 4 All elements 5 5. History-taking skills No elements 1 6. Diagnostic reasoning and management No elements 1 2 3 Overall impression Clear fail 1 Borderline fail 2 Pass 3 Good 4 Excellent 5 Please record specific feedback below for discussion: 44e1 Back pain 2 SPECIFIC CHECKLIST FOR THIS STATION 1. Introduction and approach to patient • • • • Introduces themselves to patient Obtains consent for interview Indicates confidential nature of consultation Sets patient at ease 2. Main presenting symptoms • Elicits character of the pain including site, radiation, and exacerbating and relieving factors • Elicits timescale of symptoms • Asks specifically about ‘red flag’ symptoms 3. Relevant supporting information • • • • Elicits social history including employment history Asks how pain is affecting function Asks about linked conditions—previous fractures, history of osteoporosis Asks about family history of relevant conditions 4. Patient’s perception and understanding • Asks for patient’s ideas, concerns and expectations • Responds to concerns and expectations appropriately • Specifically elicits and responds to fear of cancer 5. History-taking skills • • • • Develops rapport with patient Use of open questions Questions follow from patient’s responses Focuses history to ask about red flag symptoms 6. Diagnostic reasoning and management • • • • 44e2 Reaches likely diagnosis of vertebral fracture Discusses supporting features for this Considers differential diagnosis Discusses likely diagnosis with patient, avoiding medical terminology and checking understanding
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