When did the symptom start, what makes it better or worse, how would you describe its quality, does it radiate, how severe is it on a 0‑10 scale, and what is its timing pattern?

OPQRST Mnemonic Questions for Illness History

Use these six questions to systematically capture every critical element of symptom characterization: "When did this start?", "What makes it better or worse?", "How would you describe what it feels like?", "Does it spread anywhere else?", "On a scale of 0 to 10, how severe is it?", and "Does it come and go or stay constant?"

Structured Question Framework

O – Onset

• "When did this symptom start?" 1
• Document the specific date and time when symptoms first appeared, using exact timing when possible (within 15 minutes) 1
• If exact time is unknown, use standardized time parameters: morning (6:00 AM-11:59 AM), afternoon (noon-5:59 PM), evening (6:00 PM-11:59 PM), or overnight (midnight-5:59 AM) 1
• For intermittent symptoms, record when the most recent episode began 1

P – Provocation/Palliation

• "What makes it better or worse?" 1
• Identify aggravating factors that worsen the symptom 1
• Identify relieving factors that improve the symptom 1
• Document activities, positions, medications, or interventions that affect symptom intensity 1

Q – Quality

• "How would you describe what it feels like?" 1
• Use the patient's own descriptive words for the sensation 1
• For pain: sharp, dull, burning, crushing, stabbing, aching 1
• For other symptoms: document specific characteristics (e.g., productive vs. dry cough, watery vs. purulent discharge) 2, 3

R – Radiation/Region

• "Does it spread anywhere else?" 1
• Identify the primary location where the symptom is most severe 1
• Document any secondary locations where the symptom extends 1
• Note if the symptom remains localized or moves 1

S – Severity

• "On a scale of 0 to 10, how severe is it?" 1
• Use a 0-10 numerical scale where 0 = no symptom and 10 = worst possible 4
• Alternatively, use categorical scales: none, mild, moderate, severe, very severe 1
• Document functional impact: does it affect activities of daily living? 1

T – Timing/Temporal Pattern

• "Does it come and go or stay constant?" 1, 5
• Determine if symptoms are continuous, intermittent, or fluctuating 6
• Document duration: how long has each episode lasted? 1, 5
• Identify patterns: worse at certain times of day, progressive vs. stable 1, 6
• Note if symptoms are worsening, improving, or unchanged since onset 1

Clinical Application Pearls

Common pitfall: Accepting vague responses like "it hurts" without drilling down to specific quality descriptors 7

Key principle: Systematic assessment identifies 10-fold more symptoms than open-ended questioning alone, with 69% of severe symptoms and 79% of distressing symptoms missed without structured inquiry 7

Documentation standard: Each element should be recorded with sufficient detail to establish baseline severity and track response to treatment over time 1