11/13/24, 8\:08 PM Guide | Collateral history

Collateral history

Table of contents

Introduction

Taking a collateral history is an important skill that can be assessed in OSCEs. This guide provides a structured approach to
taking a collateral history in an OSCE setting.

Background

In most cases, it is best to take a history from the patient directly, but sometimes the patient is unable to give you the
information you need, for example, if they are confused or if they lost consciousness (e.g. seizure/syncope).
In these situations, a collateral history should be taken from a close family member, friend or witness.
This should be taken as soon as possible after the patient is admitted so that an accurate diagnosis and an appropriate
management plan can be made.

Before the consultation

Before approaching a patient’s family member/friend/witness for information, gain the patient’s consent if they have capacity.
It is also a good idea to review the patient’s notes so that you can con
and prioritise collecting any information that is missing.

Opening the consultation

Wash your hands and don PPE if appropriate.
Introduce yourself including your name and role.
Con
Explain that you’d like to take a collateral history.
Gain consent to proceed with history taking.
General communication skills
It is important you do not forget the general communication skills which are relevant to all patient encounters.
Demonstrating these skills will ensure your consultation remains patient-centred and not checklist-like (just because
you're running through a checklist in your head doesn't mean this has to be obvious to the patient).
Some general communication skills which apply to all patient consultations include\:
Demonstrating empathy in response to patient cues\: both verbal and non-verbal.
Active listening\: through body language and your verbal responses to what the patient has said.
An appropriate level of eye contact throughout the consultation.
Open, relaxed, yet professional body language (e.g. uncrossed legs and arms, leaning slightly forward in the chair).
Making sure not to interrupt the patient throughout the consultation.
Establishing rapport (e.g. asking the patient how they are and o
https\://app.geekymedics.com/osce-guides/history/collateral-history/ 1/511/13/24, 8\:08 PM Guide | Collateral history
Signposting\: this involves explaining to the patient what you have discussed so far and what you plan to discuss next.
Summarising at regular intervals.

Presenting complaint

If you were unable to determine the patient’s presenting complaint from the patient or their notes, you may need to ask the
patient’s family member/friend/witness for more information.
Use open questioning to explore the patient’s presenting complaint.
“ W h y w e r e t h e y b r o u g h t i n t o h o s p i t a l t o d a y ?”
“ T e l l m e a b o u t t h e i s s u e s t h e y h a v e b e e n e x p e r i e n c i n g”
" W h a t d i d y o u w i t n e s s o c c u r ?"

History of presenting complaint

Ask the patient’s family member/friend/witness to give you more details about the presenting complaint if they are able to.
The questions you should ask will vary depending on the presenting complaint.
Remember that the family member/friend/witness will only be able to give you information from what they have seen or what
the patient has told them. For example, they would not be able to tell you how the pain feels.
A useful question to ask is\:
“ W h e n w a s t h e p a t i e n t l a s t w e l l ?”
This will give you an idea about whether the problem is acute or chronic. It also enables you to explore with the family
member/friend/witness what has happened since then, in chronological order.
Summarising
Summarise what the family member/friend/witness has told you about the presenting complaint. This allows you to check
your understanding of the patient’s history and provides an opportunity for the family member/friend/witness to correct any
inaccurate information.
Once you have summarised, ask the family member/friend/witness if there’s anything else that you’ve overlooked. Continue
to periodically summarise as you move through the rest of the history.
Signposting
Signposting, in a history taking context, involves explicitly stating what you have discussed so far and what you plan to discuss
next.
Signposting can be a useful tool when transitioning between di
member/friend/witness with time to prepare for what is coming next.
“ S o f a r w e h a v e t a l k e d a b o u t y o u r f a m i l y m e m b e r’ s s y m p t o m s s i n c e t h e y b e c a m e u n w e l l . p a s t m e d i c a l h i s t o r y .
”
I w o u l d n o w l i k e t o d i s c u s s t h e i r

Past medical history

Medical history
Ask the patient’s family member/friend/witness if they know whether the patient has any medical conditions.
If the patient does have a medical condition, you should gather more details to assess how controlled the disease is and what
treatment(s) the patient is receiving. It is also important to ask about any complications associated with the condition
including hospital admissions.
Surgical history
https\://app.geekymedics.com/osce-guides/history/collateral-history/ 2/511/13/24, 8\:08 PM Guide | Collateral history
Ask if the patient has previously undergone any surgery or procedures.
Allergies
Ask if the patient has any allergies and if so, clarify what kind of reaction they had to the substance (e.g. mild rash vs
anaphylaxis).

Drug history

Ask if the patient is currently taking any prescribed medications or over-the-counter remedies. If the patient is taking
prescribed or over the counter medications, document the medication name, dose, frequency, form, and route.
You should also ask whether the patient has recently started or stopped any medications because side e
may be contributing to their presenting complaint (e.g. seizure).
Another important question to ask is whether the patient is taking their medications as prescribed. Does the patient ever refuse
their medication or forget to take it? Do they use a compliance aid?

Baseline cognition

If the patient was unable to give you their history due to confusion, it is important to determine their baseline level of
cognition.
Questions you could ask the family member/friend include\:
“ D o e s t h e p a t i e n t u s u a l l y h a v e p r o b l e m s w i t h t h e i r m e m o r y ?” a n d i f s o ,
“ H o w l o n g h a s t h i s b e e n go i n g o n f o r ?”
“ H a s t h e p a t i e n t’ s b e h a v i o u r c h a n g e d r e c e n t l y ? F o r e x a m p l e , h a v e t h e y b e e n ge t t i n g m o r e a ggr e s s i v e o r h a v i n g
h a l l u c i n a t i o n s ?”
“ D o t h e y h a v e a d i a g n o s i s o f d e m e n t i a ?” a n d i f n o t ,
“ A r e t h e y a w a i t i n g i n v e s t i ga t i o n s f o r p o s s i b l e d e m e n t i a ?”
You should also sensitively ask whether the patient could be a risk to themselves or others, for example leaving the stove on
or wandering at night.

Baseline mobility

Awareness of a patient’s baseline mobility is critical when planning for a patient’s discharge.
Usually, if a patient was walking with a stick before admission, the aim is to make sure they are able to walk with a stick before
discharge.
If the patient is not mobilising at their baseline during their hospital stay, they are likely to bene
physiotherapist.
Questions you could ask the family member/friend include\:
“ H o w f a r c a n t h e p a t i e n t u s u a l l y w a l k w h e n t h e y a r e w e l l ?”
“ D o t h e y n e e d a s s i s t a n c e w h e n m o v i n g a r o u n d i n d o o r s ? F o r e x a m p l e , “ D o t h e y n e e d a s s i s t a n c e w h e n m o v i n g a r o u n d o u t d o o r s ? F o r e x a m p l e , w h e e l c h a i r ?”
d o t h e y u s e a w a l k i n g s t i c k , d o t h e y u s e a w a l k i n g s t i c k , a f r a m e , a f r a m e , o r a w h e e l c h a i r ?”
o r a

Living arrangements

Awareness of a patient’s home circumstances is particularly important when planning for the patient’s discharge.
Collecting this information as soon as possible after admission will help to prevent delays to the patient’s discharge, once they
are medically stable.
Questions you could ask the family member/friend include\:
“ D o e s t h e p a t i e n t l i v e w i t h a n y o n e e l s e ?”
https\://app.geekymedics.com/osce-guides/history/collateral-history/ 3/511/13/24, 8\:08 PM Guide | Collateral history
“ D o t h e y h a v e i n f o r m a l o r f o r m a l c a r e r s ?” I f s o ,
“ H o w o f t e n d o t h e y v i s i t ?” a n d ,
p a t i e n t’ s n e e d s ?”
“ W h a t t y p e o f h o m e d o e s t h e p a t i e n t l i v e i n ? F o r e x a m p l e , i s i t a h o u s e ,
“ D o e s t h e i r h o m e h a v e a n y s t a i r s ?” I f s o ,
“ I s t h e r e a s t a i r l i f t ?”
“ A r e t h e r e a n y s t e p s i n t o t h e p r o p e r t y ?”
“ D o t h e c a r e r s f e e l a b l e t o a d d r e s s a l l o f t h e

Continence

It is important to speci
unprompted.
If a patient is incontinent during their hospital stay, it should not just be assumed that the patient is incontinent at home.
Questions you could ask the family member/friend include\:
“ I s t h e p a t i e n t u s u a l l y c o n t i n e n t o f u r i n e ?”
“ I s t h e p a t i e n t u s u a l l y c o n t i n e n t o f f a e c e s ?”
I f t h e y a r e n o t c o n t i n e n t ,
“ H o w i s t h i s u s u a l l y m a n a g e d a t h o m e ?”

Activities of daily living

Determining which activities of daily living a patient can usually perform independently is another important aspect of the
collateral history.
If the patient is unable to perform these activities independently during their hospital stay, they may bene
an occupational therapist before discharge.
Activities of daily living include\:
Washing themselves
Dressing themselves
Toileting themselves
Managing medications
Cooking
Cleaning
Shopping
Managing their
Ask the family member/friend whether the patient can usually complete the above activities of daily living independently. If
they cannot, ask who helps them with those activities.
It is also bene
You should also ask whether the patient drinks alcohol, smokes tobacco, or uses recreational drugs.

Advance care planning

It is often useful to
as CPR, especially if the patient is currently unable to discuss them with you themselves.
You could sensitively ask the family member/friend the following questions\:
“ H a s t h e p a t i e n t p r e v i o u s l y d i s c u s s e d t h e i r t h o u gh t s a b o u t C P R w i t h t h e i r G P o r s o m e o n e c l o s e t o t h e m ?” I f s o ,
p a t i e n t h a v e d o c u m e n t a t i o n o f t h i s d i s c u s s i o n i n w r i t i n g ?”
“ H a s t h e p a t i e n t e x p r e s s e d a n y o t h e r t h o u g h t s a b o u t m e d i c a l t r e a t m e n t s t h e y w o u l d n o t w a n t ?”
“ D o e s t h e p a t i e n t h a v e a l a s t i n g p o w e r o f a t t o r n e y f o r h e a l t h a n d w e l f a r e ?”
It can also be useful to ask\:
“ W h a t i s m o s t i m p o r t a n t t o t h e p a t i e n t ?”
“ D o e s t h e
https\://app.geekymedics.com/osce-guides/history/collateral-history/ 4/511/13/24, 8\:08 PM Guide | Collateral history
The patient may wish to stay within their own home for as long as possible, or they may wish to spend as much time as they
can with their spouse, for example. The answer to this question may help you to determine what would be in the patient’s best
interests.

Closing the consultation

Summarise the key points back to the family member/friend.
Ask the family member/friend if they have any questions or concerns that have not been addressed.
Thank the family member/friend for their time.
Dispose of PPE appropriately and wash your hands.

Reviewer

Consultant Geriatrician

References

1. Fitzpatrick D, Doyle K, Finn G, Gallagher P. The collateral history\: an overlooked core clinical skill. Published 23 July 2020.
Available from\: [LINK]
Source\: geekymedics.com
https\://app.geekymedics.com/osce-guides/history/collateral-history/ 5/5