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Form Frustration: Interim History

02/01/2018

"ESTABLISHED PATIENT INFORMATION FORM" from a major university medical center for the sports medicine clinic. LOL. As if I might mistake the piece of paper for a lawnmower! First, instead of handing the form to the patient when signing in, the clinic should send the form digitally before the appointment to allow the patient to complete it legibly with a keyboard, to let the patient get information they keep at home, and to allow instant incorporation into the digital record.

"RIGHT or LEFT Handed?": Seriously, how often does "handedness" change from one encounter to the next?

  1. Anatomical diagram: Mark the painful areas. Fine as is.
  2. Last revised in November of 2014, the form still lists the name of a physician who left the clinic long ago, and my physician's name does not appear. Patient: Cross out the old doc, write in the new one.
  3. "What is your PAIN INTENSITY?": WHICH pain? If only there was only one. Do they mean overall, the worst one, the one I want to get help with today? "Please CIRCLE one)": What if the pain varies from 3-8? By the way, "10" is identified as "Worst Pain Imaginable." If that's what the patient uses as a ten, the physician might as well "imagine" the intensity of the pain. Use "Worst Pain Ever" instead, and the physician, having asked the patient what that was, will have a more precise idea of the current level of pain. Patient: Cross it out and correct accordingly.
  4. Describe the quality of pain: Again, different pains -- different descriptions. Patient: Mark all that fit.
  5. "Is your pain CONSTANT or INTERMITTENT?": How about "Yes?" Fair question, but again it may differ according the pain in question, and this should not appear as answerable by yes/no. Just add "circle one."
  6. "What makes your symptom(s) BETTER?": Fine as is.
  7. "What makes your symptom(s) WORSE?": Fine as is.
  8. [Abbreviated interim review of symptoms]: Yes/no boxes are quite appropriate, but what does "recently" mean? If they want changes since the last encounter, they should say so. 
  9. "What MEDICATION(S) are you taking for your pain?": Would you believe this is first time I noticed they do not ask for a list of ALL my meds!? Duh. Present tense fails here. I propose: "What MEDICATION(S) [have you taken since your last encounter] for your pain?" Patient: Cross out "are," and answer as appropriate.
  10. "Since your LAST visit, which other providers have you seen for your symptoms?...": WHICH symptoms? I cannot tell what they want to know here. Might "problem(s)" elicit more useful information? Regardless, who carries all their providers "Addresses" to appointments with this clinic?

On the back the form asks about changes in medical history. Again that word vague term "recently" pops up, but only for "surgeries," while the main question says, "since your LAST visit." What if "recent" and "since your last visit" do not mean the same thing? 

"REVIEW OF SYMPTOMS": Doctor: If you want to know about "symptoms," list only symptoms. This list includes "Glasses/Contacts," "Heart Attack," "Heart Failure," "Asthma," and many other items that do not qualify as symptoms. Most qualify as diseases or injuries. For example, under "MENTAL HEALTH" (Would mental "ILLNESS" (or just "Mental") not be more appropriate?), anxiety and depression qualify as symptoms. "Bipolar" and "Schizophrenia" do not. Neither does "Unusual Stress at Home or Work."

I encourage patients to make corrections to such forms as indicated, and make sure to tell your providers what the forms fail to communicate.

I encourage providers to not only use my ideas above, but get involved with form design. Do not leave it to an administrator to determine the information on which you will base clinical decisions, and before you use a form in your practice or clinic, try completing it as though you were the patient.