Communication

including history taking, documentation...

OLD CARTS Symptom Exploration

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While undertaking a complete and accurate clinical history from a patient, it is essential to understand each symptoms characteristic. By obtaining the full information regarding the symptoms will enable the practitioner in the formulation of the differential diagnosis. Bickley et al. (2017) outline seven key attributes which should be obtained from the patient concerning each presenting symptom. These include:  
Location
Where is it? Does it radiate anywhere?
Quality
Quantity or Severity
Timing
Settings in which it occurs
Remitting or exacerbating factors
Associated manifestations
A great way of remembering to extrapolate the seven attributes is to use a mnemonic as a memory aid. A mnemonic I use in practice is OLD CARTS:
Onset: when did your symptom(s) start?
Location; where is it located? Do your symptoms radiate anywhere?
Duration; how long have you had your symptom(s)?
Character; do you symptoms change with certain activities? How would you describe your symptoms?
Aggravating factors; what makes your symptoms worse?
Relieving factors; what makes your symptom(s) better?
Timing; is it constant or fluctuating? Does it have a pattern?
Severity/Score; how bothersome are your symptoms? How painful is the presenting complaint (use a scoring system)?
We love mnemonics and hope you do too, are you aware of any other? Do you have anything to contribute or discuss relating to this post? Leave us a comment below. If you have enjoyed this post, please share with your friends and colleagues.


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