When you take a patient's medical history, what questions do you ask? How do you interpret your patient's answers? Taking a comprehensive and accurate medical history requires artful skill at asking questions and listening, as Dr. Robert Centor explains:


"As we read mystery novels, the detective often has to reexamine the “subjective” information.  What did the witness really say; what did the witness really mean? We must have the same mindset.  We are detectives, and the patient (and family and friends) are the witnesses.  If we ask the proper questions and make certain that we really understand what the patient has experienced, we are much more likely to arrive at the correct diagnosis quickly. "


As a pediatric physician or nurse, the added layer of interpreting symptoms through a third party makes this process even more challenging. It important to remember to not jump to conclusions about the patient's symptoms without truly listening to your patient describe their symptoms:


"We must not put our interpretation on the words the patient uses, but rather elucidate their meaning.  When we learn to do so, we become artists of the best kind."


While taking a medical history presents challenges, it also provides the opportunity to implement trauma informed care and assess a patient's and family's psychosocial health. The DEF Protocol gives you a framework in which to do this:


D- Distress

DEF Protocol for Trauma Informed Care

- Assess and manage pain

- Ask about fears and worries

- Consider grief and loss


E-Emotional Support

- Who and what does the patient need now?

- Barrier to mobilizing existing supports?



- Assess parents' or siblings' and others' distress

- Gauge family stressors and resources

- Address other needs (beyond medical)  


Incorporating the DEF Protocol with each and every patient is important. Incorporating the DEF Protocol exactly as above with each and every patient is not as important because the circumstances surrounding each patient will be different. Keeping this framework in mind as you take a medical history allows you to mold the protocol to the patient and the situation while gaining valuable insight into any potential psychosocial needs which may affect your patient's  adherence and / or  recovery.


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