How do I elicit the chief complaint from a patient?

How to Elicit the Chief Complaint from a Patient

Begin by asking a general, open-ended question such as "What brings you in today?" or "What can I do for you today?" to allow the patient to present their concerns in their own words. 1

Opening Question Strategy

Use a general inquiry format rather than a confirmatory question when you don't already know the patient's concern. 2

• Ask questions like "What brings you here today?" or "Tell me what's going on" to elicit the most complete information 1, 2
• General inquiries produce significantly longer problem presentations with more discrete symptoms compared to confirmatory questions (e.g., "I understand you're having sinus problems?") 2
• Open-ended questions are positively associated with obtaining more information from patients 3

Essential Follow-Up Questions

After the initial open-ended question, orient yourself to the patient's understanding and agenda by asking: 1

• "What are the things you want to make sure we discuss today?" 4
• "Tell me what you understand about why you're here" 4
• "What have other clinicians told you?" 1

These questions give the patient control over the conversation and help you understand their perspective before diving into your own concerns. 4

Active Listening Techniques

Listen without interrupting and construct your questions based on what you've heard. 1

• Allow the patient adequate time to process and respond 1
• Use reflective listening by stating "Tell me if I have this right..." or "What I heard is that..." 1, 4
• Hold silence until the patient is ready to continue speaking 4
• Avoid assuming quiet patients don't want to participate—ask directly "I'm wondering what you're thinking or if I'm missing something?" 4

Creating the Right Environment

Sit down at the patient's level to convey you have time and are not rushed. 4

• Maintain two arms' length distance to respect personal space 1, 4
• Ensure privacy with an unobstructed path out of the room 1, 4
• Make eye contact and keep hands visible and unclenched 4
• Use a calm demeanor and facial expressions 1

Common Pitfalls to Avoid

Do not use confirmatory questions (e.g., "You're here for your diabetes follow-up, right?") as your opening unless you already know the specific reason for the visit, as these limit the information patients provide. 2

• Avoid jargon and medical terminology 1
• Don't interrupt or provide multiple messages that may confuse the patient 1
• Resist the urge to jump to solutions before fully understanding the patient's concern 4

Responding to What You Hear

Acknowledge and validate emotions when patients express them verbally or nonverbally. 1

• Name the emotion: "You seem worried today" 1
• Use partnership statements: "I want to make sure we do everything we can to help you" 1
• Explore what's behind strong emotions: "Tell me what you are worried about" or "What has been the hardest part for you?" 1, 4

Checking Understanding

Use the "teach back" method to ensure you've correctly understood the chief complaint. 1, 4

• Ask "In your own words, what does this mean to you?" 1, 4
• Provide information in small doses and check for comprehension frequently 1, 4