By the nature of emergency medicine minimal information is provided regarding the presenting complaint. In this case it consisted of “swollen legs, can’t walk.” This helps to remove the issue of diagnostic anchoring or confirmation bias, recognised as a threat to appropriate decision making, however it places the onus on the clinician to be thorough (RCEM, 2017). Arriving at the property a list of differential diagnoses was being considered. These included heart failure, liver or kidney disease, cellulitis, deep vein thrombosis (DVT), drug interactions, lymphoedema, COPD and trauma.
The patient was sat in her living room in a relaxed manner and greeted me as I entered. She was alert, well perfused with no obvious disability but appeared slightly breathless. Using the ABCDE model, considered an effective tool for initial assessment, the patient was deemed not to require immediate interventions (Thim et al, 2012). I introduced myself and confirmed she was the person who had called for the ambulance. Due to the initial perception of breathlessness a baseline set of vital signs were taken to establish the need for a time critical decision. Values within normal range were recorded allowing the consultation to progress.
Using an open question I inquired “How can I help you today?” and proceeded to actively listen to the reason she had dialled 999, an important skill to ensure maximal verbal and non-verbal information is ascertained (Dickson et al, 1989). She disclosed a 3 day history of progressive swelling in the lower part of both legs accompanied by mild shortness of breath. She additionally reported walking was increasingly difficult due to pain in her joints. In order to ascertain pertinent details and prevent misdirection the patient was led via less generalised questions, a process known as funnelling (Rahman and Tasnim, 2007). The pneumonic SOCRATES was used to aid the funnelling process as it is recognised to help elicit specific information related to a health complaint (Burns, 2015). At this point the patient was provided with a summary of her complaint, important for clarifying details and demonstrating an understanding of her condition (Lloyd and Craig, 2007). Goold and Lipkin (1999) identified a direct link between the quality of information provided and patient