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This history will usually refer to a middle-aged/elderly male complaining or urinary symptoms. The main purpose of the history will be to distinguish whether this condition is benign (BHP) or something more sinister, such as prostate/bladder cancer. In addition, for a younger patient, we might also be concerned with a STI.
So what are some common conditions which might cause urinary frequency?
Urinary tract
- Benign prostatic hyperplasia
- Prostate cancer
- Bladder cancer
- Over-active bladder
Infection
- UTI
- STI
Looking at these differentials, the systems we have to explore are the urinary system and possible sexually transmitted infections. Again when going through the symptoms, we should enquire both about the urine frequency, onset, time but also about the physical quality of the urine (colour, blood etc.)
Introduction
- Good afternoon, my name is _______ and I am one of the student doctors here. Is it _______(patient’s name)?
- I just wanted to ask you some questions about how you are feeling and what has brought you in to see the doctor today, and then I’ll take that information, relay it to the consultant and we can go from there.
- Before I start, are you comfortable or would you likely me to get you anything? Do you mind if I take a seat?
- So, what has brought you in to see the doctor today?
(P) Presenting Complaint
- Summarise patient’s answer and ask first screening question) – Apart from this, have you noticed anything else?
- (Ask second screening question) – Ok, anything else?
- (Ask third screening question) – Before talking more about your [symptom], are there any other symptoms?
- (Last screening question) – Are you sure that there is nothing else?
- (Once we are sure there are no other questions, we can now address each symptom in turn) – Now I just want to ask some questions about the symptoms you have been feeling? Go through each symptom using OATES or SOCRATES for pain
- Urinary frequency – You mentioned that you have been going a lot more often, can you tell me a bit more about this?
| Onset | When did you first notice this? |
| Associations | Is this associated with any other symptoms? |
| Time | How many times do you go to the toilet a day? |
| Exacerbations | Is there which makes this better/worse such as drinking coffee? |
| Specifics | When you do go to the toilet? Colour: What colour is it? Blood: Is there any blood? Smell: Does it have a strange smell? Ease: Does it come out easily or do you have to strain? Pain: Do you get any pain or stinging sensation? |
- Blood in the urine – Could you tell me a little more about this?
| Onset | When did these this start? |
| Associations | Is this associated with any other symptoms? |
| Time | How many times has this happened? |
| Exacerbations | Is it getting worse? |
| Specifics | Does it bleed at the beginning or after you start? How much blood is there? |
(I) Ideas, Concerns, Expectations
- Ok, you have been feeling these symptoms for some time, do you have any idea of what it could be?
- Are you particularly concerned about anything?
- What were you hoping to get out of the visit today?
(S) Systems Review
- (In response to them telling you their expectation from today’s visit) Ok, in order to do that, first I would like to ask you a few more specific questions just to get a more accurate picture of why you might be experiencing these symptoms.
Specific Systems Review
- Urinary:
Do you get any pain in the area?
- STI:
Are you sexually active at the moment?
Have you had any unprotected sex recently?
Is there any discharge from the penis?
General Systems Review: (Ask general questions to rule out red flags):
(Fever) Have you got a fever?
(Glands) Have you got any swollen glands?
(Weight) Have you noticed any weight loss?
(Appetite) Have you noticed any changes in your appetite?
(Bowels) Have you experienced any changes in your bowel movements?
(Waterworks) Are your waterworks all fine?
(Tired) Have you been feeling more tired than usual?
(Travel) Have you travelled anywhere recently?
(Night sweats) Do you wake up in the night drenched in sweat?
(Rash) Have you got any rashes?
(If woman, and abdominal pain, enquire about pregnancy) Are you on the contraceptive pill? Is there a chance you could be pregnant?
(P) Past Medical History
- And now, about your health in general, have you ever seen your doctor about something like this before?
- Do you have any other medical conditions, such as diabetes, blood pressure or asthma?
- Have you ever had any surgeries?
- Have you ever been admitted into hospital before?
(F) Family History
- Is there any incidence of urinary conditions in your family?
- Are there any other conditions which run in your family?
(D) Drug History
- Are you currently taking any prescribed medication?
- Do you take anything else, over the counter?
- Do you have any allergies?
(S) Social History
- (Work) And now, a little but more about yourself in general, do you work at the moment? What do you do?
- (Home) Do you live with any family or friends? Are you married? Do you have any children?
- (Independence) Would you say that you are fairly independent?
And now these are some questions that we ask everyone:
- Do you smoke? (Have you ever smoked? / When did you start? / How many a day?)
- Do you drink? (How much a week? And for how long?)
- Is there any recreational drug use?
