Structured and systematic frameworks are widely accepted as useful tools for effective history taking, ensuring vital and important symptoms are not missed (Young and Duggan, 2009 and Alyami et al., 2016). The OLDCART ICE aide memoire was used to facilitate a systematic, encompassing and focused history while simultaneously gathering information as to Lucy’s ideas, concerns and expectations (Goldberg, 2015 and Price, 2000, Moulton, 2007). Questioning needed to include the use of closed questioning techniques, recognised as effective in exploring in sufficient depth to exclude the presence of “red flag” symptoms suggestive of a serious condition (Shepherd, 2013 and van der Velden, 2013).
Lucy described a three-day history of feeling generally unwell (general malaise) and a sore throat causing pain and difficulty in swallowing (odynophagia). No obstruction was reported. No history of a cold. She described a fever, but had not taken her temperature. Chronology, mode of onset, course of presentation and pain severity are all important diagnostic differentials (Shepherd, 2013, Muhrer, 1991 and Ebell et al., 2013). An onset of three days stratified this presentation as acute, a significant finding on which a decision for treatment could be based (Little et al., 2013). ‘Red flags’ of a cardiac problem were ruled out by enquiring about location of her throat pain, which was bilateral in presentation and radiating just to the ears. There was no stridor or any other sign of respiratory distress. There was no drooling of saliva, no muffled, hoarse, or “hot-potato” voice, all signs which could be suggestive of epiglottitis or the presence of a foreign body