Lesson 2.2: Taking a History
History taking is the heart of most PLAB 2 stations. A well-structured history demonstrates clinical reasoning, builds rapport, and keeps you from missing the diagnosis that matters.
Universal History Framework
| Component | What It Covers |
|---|---|
| History of Presenting Complaint (HPC) | The main event. Start with an open question, then focus progressively using SOCRATES (for pain) or FODPARA (for non-pain symptoms) below. |
| Differential Screening | Targeted red flag questions to rule out the most serious causes of the presenting complaint. |
| Background History | PMAFTOSA — past medical history, medications, allergies, family history, travel, occupation, social history, anything else. |
| ICE | Ideas, Concerns, Expectations — covered in Lesson 2.3. |
For Pain: SOCRATES
| Letter | Focus | Example Question |
|---|---|---|
| S — Site | Where is the pain? | "Where exactly is the pain? Can you point to it?" |
| O — Onset | Sudden or gradual? | "When did it start? Did it come on suddenly or build up over time?" |
| C — Character | Type of pain | "What does it feel like — sharp, dull, burning, crushing, cramping?" |
| R — Radiation | Does it spread? | "Does it go anywhere else — your arm, jaw, back, or groin?" |
| A — Associated symptoms | What else is happening? | "Any other symptoms alongside the pain?" |
| T — Time course | Constant or episodic? | "Is it constant or does it come and go? Getting better, worse, or the same?" |
| E — Exacerbating / Relieving | What affects it? | "What makes it worse? Is there anything that helps?" |
| S — Severity | How bad? | "On a scale of 0 to 10, how bad is it at its worst?" |
For Non-Pain Symptoms: FODPARA
When the complaint is not pain — fatigue, cough, dizziness, palpitations, diarrhoea — use FODPARA to structure your questioning.
F — Frequency: "How often does this happen?"
O — Onset: "When did this first start?"
D — Duration: "How long does each episode last?"
P — Progression: "Is it getting better, worse, or staying the same?"
A — Aggravating factors: "Does anything bring it on or make it worse?"
R — Relieving factors: "Is there anything that helps?"
A — Associated symptoms: "Any other symptoms you've noticed alongside this?"
Background History: PMAFTOSA
After the presenting complaint, cover the background systematically using PMAFTOSA. This completes the clinical picture and identifies factors that change management.
P — Past medical history: "Do you have any long-term conditions? Any previous hospital admissions or surgery?"
M — Medications: "Any regular medications? Over-the-counter remedies or supplements? Anything started or stopped recently?"
A — Allergies: "Any allergies to medications or foods? What kind of reaction do you get?"
F — Family history: "Any heart disease, cancer, diabetes, or similar in your family — particularly parents or siblings?"
T — Travel: "Any travel abroad or long journeys recently?"
O — Occupation: "What do you do for work? Any exposure to stress, dust, chemicals, or physical strain?"
S — Social history — DESA: see mnemonic below
A — Anything else?: "Before we move on — is there anything else you think I should know?"
Social History: DESA
The 'S' in PMAFTOSA — social history — has its own structure. Use DESA to make sure you cover it completely.
D — Diet: "Would you say you have a fairly balanced diet?"
E — Exercise: "Do you get much physical activity or exercise?"
S — Smoking: "Do you smoke — how many and for how long?"
A — Alcohol: "How much alcohol would you say you drink in a week?"
Also ask where relevant: 'Who do you live with?' and 'Do you drive?' (important for seizures, blackouts, visual problems, or sedating medications).
Universal Red Flags — Screen in Every Consultation
- Unintentional weight loss
- Night sweats
- Loss of appetite
- Fatigue out of proportion to the history
- Any symptom that wakes the patient from sleep
- Any unexplained bleeding — haemoptysis, haematemesis, rectal bleeding, haematuria
Cancer Red Flags: FLAWS
Whenever a presentation could plausibly represent malignancy, screen explicitly using FLAWS — these are the systemic features that should raise your suspicion regardless of the presenting complaint.
F — Fever: unexplained or persistent
L — Lumps / bumps: "Have you noticed any new lumps or swellings anywhere?"
A — Appetite: "Has your appetite changed at all?"
W — Weight loss: unintentional — always quantify: how much, over what period
S — Sweating: night sweats — "Have you been waking up with night sweats?"
FLAWS sits alongside the universal red flags above — the two overlap deliberately. Weight loss and night sweats appear in both because they are that important. Screening for FLAWS explicitly in any case with vague or systemic symptoms (fatigue, weight change, lymphadenopathy) demonstrates safe clinical reasoning to the examiner.
System-specific red flags are covered in Lesson 2.6 and the clinical case modules.