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, 2
Opening Question Strategy
Use a general inquiry format rather than a confirmatory question when you don't already know the patient's concern. 3
- Ask questions like "What brings you here today?" or "Tell me what's going on" to elicit the most complete information 2, 3
- General inquiries produce significantly longer problem presentations with more discrete symptoms compared to confirmatory questions (e.g., "I understand you're having sinus problems?") 3
- Open-ended questions are positively associated with obtaining more information from patients 4
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?" 5
- "Tell me what you understand about why you're here" 5
- "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. 5
Active Listening Techniques
Listen without interrupting and construct your questions based on what you've heard. 2
- Allow the patient adequate time to process and respond 6
- Use reflective listening by stating "Tell me if I have this right..." or "What I heard is that..." 2, 5
- Hold silence until the patient is ready to continue speaking 5
- Avoid assuming quiet patients don't want to participate—ask directly "I'm wondering what you're thinking or if I'm missing something?" 5
Creating the Right Environment
Sit down at the patient's level to convey you have time and are not rushed. 5
- Maintain two arms' length distance to respect personal space 6, 5
- Ensure privacy with an unobstructed path out of the room 6, 5
- Make eye contact and keep hands visible and unclenched 5
- Use a calm demeanor and facial expressions 6
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. 3
- Avoid jargon and medical terminology 1
- Don't interrupt or provide multiple messages that may confuse the patient 6
- Resist the urge to jump to solutions before fully understanding the patient's concern 5
Responding to What You Hear
Acknowledge and validate emotions when patients express them verbally or nonverbally. 1, 2
- 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, 5
Checking Understanding
Use the "teach back" method to ensure you've correctly understood the chief complaint. 1, 5