General principles Clinical assessments are integral to undergraduate and postgraduate medical education and training, and are designed to verify that those involved in the care of patients meet safe clinical standards. Assessments can be formative and/or summative. Formative assessments (such…
The previous chapters have covered the idealised process of taking a history and examining each system in depth. This chapter considers how this ‘toolbox’ of skills can be used selectively and adaptively to address the patient’s needs in specific circumstances.…
History taking, examination and investigation are the methods by which clinicians gather information to allow them to understand patients’ problems. Clinical reasoning is the analytical process by which this information is translated into diagnoses, therapeutic possibilities and prognoses. This chapter…
Around 1% of the population in high-income countries die each year. Although some deaths are unexpected, the majority are the result of one or more advanced, progressive conditions and occur in hospital, at the patient’s home or care home, or…
A deteriorating patient is one who becomes acutely unwell in the hospital setting. This can occur at any stage of a patient's illness but is more common if the patient has been admitted as an emergency case, has undergone surgery…
The frail patient A frail person typically suffers from multimorbidity (multiple illnesses) and has associated polypharmacy (multiple medications). They often have cognitive impairment, visual and hearing loss, low bodyweight, poor mobility due to muscular weakness, unstable balance and poor exercise…
Mental disorders are very common, frequently coexist with physical disorders and cause much mortality and morbidity. Psychiatric assessment is, therefore, a required skill for all clinicians. It consists of four elements: history, mental state examination (MSE), selective physical examination and…
Babies A baby is a neonate for its first 4 weeks and an infant for its first year. Neonates are classified by gestational age or birthweight ( Box 15.1 ). 15.1 Classification of newborn infants Birthweight Extremely low birthweight (ELBW): <1000 g Very…
Dermatological conditions are very common (10–15% of general practice consultations) and present to healthcare professionals in all specialties. In the UK, 50% are lesions (‘lumps and bumps’), including skin cancers, and most of the remainder are acute and chronic inflammatory…
The history Common presenting symptoms Pain In musculoskeletal pain, the acronym SOCRATES (see Box 2.2 , p. 12) suggests questions that help reveal useful diagnostic clues. Site Fig. 13.1 illustrates the anatomy of a typical joint. Determine which component is painful: the…