How to structure your diagnosis:

 

When diagnosing a patient, it is important to ensure you follow a logical order of questioning to ensure the conversation flows and that you have all the information necessary to make the correct diagnosis.

 

To do this, it can be helpful to follow the WWHAM sequence of questioning:

 

WHO is the treatment for?

WHAT are their symptoms?

HOW long have they had their symptoms?

ACTIONS already taken?

MEDICATIONS they are taking?

 

 

Other hints for diagnosis:

 

Listen to the patient- if they open the conversation by telling you they have a headache, don't then re ask who the treatment is for.

 

Ask if there are any other symptoms- a patient will often tell your their main symptom, such as a headache, but may not disclose other symptoms such as photophobia.

 

Ask if they have had the symptoms before- recurring symptoms may need to be referred.

 

Be aware that patients who are taking long term medication may not class these as relevant to the problem they are currently having so may not mention them. It is worth checking with patients whether they are taking anything their GP has prescribed them, as well as anything they may have bought over the counter.

 

If a woman (or male asking for their female partner) asks for medication you may need to check whether they are pregnant or breastfeeding. If you are unsure whether the medication is suitable for a pregnant/ breastfeeding women, this information can be found in the BNF or Patient Information Leaflet.

 

Look at the patient, it may be immediately obvious if they are unwell. For example, if a child is very quiet and not eating this is a clear indication something is wrong.

 

For a complete consultation, look at social and lifestyle factors, for example, drinking, smoking and family history.

 

Be aware the age/gender may alter the likelihood of a condition.

 

Know when to refer conditions to a GP.

 

Tips for counselling:

 

Remember to introduce yourself to begin a conversation properly, and to always finish with a summary of what you have covered, and to ask whether they would like you to cover anything again, or have any questions.

 

Maintain eye contact with a patient- it shows you have confidence in what you are saying and also makes it easier for you to see if they understand. Patients may feel embarrassed to say they are confused, but it can be obvious by their body language and facial expressions, which indicates you may need to explain again.

 

Always take the Patient Information leaflet out of the box and show them. It is important to explain to them that if they forget any information it will be covered in the leaflet, or that they can call the pharmacy with any questions.

 

Explain any side effects- but remember most are very rare. This should be explained to the patient to ensure that they don't decide not to take their medication for fear of the side effects. If they experience any side effects they should call the pharmacy or their GP.

 

Be sure to get the timings of doses complete- for example, telling someone to take paracetamol "up to FOUR times a day" is not enough, they should also be told "or every FOUR to SIX hours".