Lesson 1Functional impact, activities of daily living, and occupational influencesThis section explores how to assess functional impact, activities of daily living, and occupational exposures, and how these elements inform severity assessment, disability risk, work restrictions, and tailored follow-up planning in patient care.
Evaluating baseline versus current functionAssessing basic and instrumental daily activitiesIdentifying workplace exposures and ergonomicsExploring symptom impact on job performanceDiscussing temporary restrictions and supportsDocumenting disability and return-to-work needsLesson 2Medication, allergy, and adherence assessment relevant to acute symptomsThis section covers how to elicit a precise medication list, allergy history, and adherence patterns, and how to connect these data to acute presentations, adverse drug events, interactions, and diagnostic reasoning at the point of care.
Verifying current prescription and OTC medicationsIdentifying recent medication changes and new startsClarifying drug, food, and environmental allergiesDistinguishing true allergy from nonallergic intoleranceAssessing adherence, barriers, and missed dosesLinking medications to suspected adverse eventsLesson 3Comorbidities and risk factor elicitation (HTN, diabetes, family history)This section focuses on efficiently eliciting key comorbidities and risk factors, such as hypertension, diabetes, cardiovascular and thromboembolic history, and family history, and integrating them into pretest probability and triage decisions.
Targeted review of chronic medical conditionsFocused cardiovascular and thrombotic historyEliciting diabetes and metabolic risk factorsClarifying prior surgeries and major proceduresCollecting focused family history by systemUsing comorbidities to refine pretest probabilityLesson 4Symptom characterization: onset, progression, triggers, and severityThis section details how to characterize symptoms by onset, time course, triggers, relieving factors, quality, location, and severity, and how these dimensions alter likelihoods of common and life-threatening diagnoses.
Clarifying onset, tempo, and progressionIdentifying precipitating and relieving factorsDescribing location, radiation, and qualityQuantifying severity and functional limitationDistinguishing acute, subacute, and chronicUsing symptom patterns to narrow diagnosesLesson 5How to prioritize ten or more high-yield questions for a single focused visitThis section explains how to design and prioritize a concise set of high-yield questions tailored to the chief complaint, balancing diagnostic value, safety, and time constraints during a single focused visit in urgent or primary care.
Defining the diagnostic goal of the encounterRanking questions by impact on managementUsing branching logic based on early answersBalancing open and closed questions efficientlyAdapting question sets to specific complaintsTimeboxing history while preserving safetyLesson 6Social determinants affecting diagnosis and follow-up (substance use, support, access to care)This section examines how social determinants, including substance use, housing, support networks, and access to care, shape symptom onset, diagnostic options, follow-up reliability, and risk of deterioration in undifferentiated adult patients.
Screening for alcohol, tobacco, and drug useAssessing housing, food security, and safetyEvaluating caregiver support and social isolationExploring insurance, transport, and clinic accessRecognizing work, legal, and financial stressorsIncorporating social risks into follow-up plansLesson 7Documenting and using patient responses to shape a differential diagnosis quicklyThis section teaches how to document patient responses in structured, concise language and immediately translate them into problem representations, illness scripts, and prioritized differential diagnoses that guide testing and initial management.
Transforming narratives into problem statementsHighlighting key discriminating historical featuresRecognizing pattern versus red flag mismatchBuilding and updating a dynamic differential listLinking each diagnosis to supporting dataDocumenting reasoning and diagnostic uncertaintyLesson 8Associated symptoms: cardiopulmonary, neurologic, constitutional, and GI/GU screeningThis section covers systematic screening for associated cardiopulmonary, neurologic, constitutional, and gastrointestinal or genitourinary symptoms that refine localization, uncover occult disease, and identify early warning signs.
Cardiopulmonary chest pain and dyspnea reviewNeurologic deficits, headache, and seizure queriesConstitutional symptoms and weight changeGI symptoms including pain, nausea, and bleedingGU symptoms including dysuria and retentionTailoring review of systems to chief complaintLesson 9Red flag questions for immediate escalation (syncope, severe dyspnea, chest pain, hemorrhage)This section defines red flag symptoms that require immediate escalation, such as syncope, severe dyspnea, chest pain, and hemorrhage, and teaches precise questions that rapidly uncover instability and guide urgent action.
Identifying hemodynamic instability symptomsTargeted chest pain and dyspnea red flagsRecognizing neurologic emergency symptomsEliciting hemorrhage and severe anemia signsDetermining sepsis and systemic toxicity cluesEscalation thresholds and handoff essentialsLesson 10Principles of focused history-taking in internal medicineThis section introduces principles of focused history-taking in internal medicine, emphasizing hypothesis-driven questioning, efficient structure, patient-centered communication, and integration with physical examination and early management.
Structuring the interview around the complaintUsing hypothesis-driven, iterative questioningIntegrating past history with current symptomsMaintaining rapport while staying efficientCoordinating history with targeted examinationRecognizing when to broaden the history scope
