Socrates

The Socrates Mnemonic for Pain Anamnesis

1. Site, or where the pain is.
   1. Interrogative: "Can you show me where the pain is?"
   2. Negative: "My right shoulder doesn't hurt at all."
   3. Affirmative: "I have this feeling along my lower back."
2. Onset, or when the pain began.
   1. Interrogative: "When did the throbbing begin?"
   2. Negative: "Are you saying you've had no numbness at all?."
   3. Affirmative: "I think I first felt it yesterday after dinner."
3. Character, or what the pain feels like.
   1. Interrogative: "What's it like? An ache? A stabbing?"
   2. Negative: "I didn’t throw up after the meal."
   3. Affirmative: "I threw up three times last night."
4. Radiation, or whether the pain travels elsewhere or not.
   1. Interrogative: "Did you pass out during the procedure?"
   2. Negative: "No, I didn’t pass out at all."
   3. Affirmative: "I passed out after the injection."
5. Associations, or if there are other symptoms.
   1. Interrogative: "How long did it take you to come around?"
   2. Negative: "I didn’t come around for several minutes."
   3. Affirmative: "I came around quickly after fainting."
6. Timing, or when the pain expresses itself.
   1. Interrogative: "Does it wake you up at night?"
   2. Negative: "No, it doesn't prevent me from playing ping-pong."
   3. Affirmative: "I have it mostly in the morning."
7. Exacerbating-relieving factors, or what worsens or reduces the pain.
   1. Interrogative: "The pain increases when you do what?"
   2. Negative: "Does a heat-pack alleviate the symptoms?"
   3. Affirmative: "OTC painkillers help a little bit."
8. Severity, or how bad the pain is.
   1. Interrogative: "On a scale of zero to ten, how do you rate it?"
   2. Negative: "It's bad, but I wouldn't say 'excruciating'."
   3. Affirmative: "At its worst, I have a hard time focusing on anything."

The Most Important Points to Remember

• Ask Open-Ended Questions: An open-ended question is one that can't be answered with a 'yes' or 'no' response. It's phrased as a statement which requires a longer answer. Encourage your patient to describe their pain in their own words. For instance, instead of asking, "Does it hurt?" ask, "Can you describe how it feels?"

• Use Layperson Language: Avoid medical jargon that might confuse the patient. Tailor your language to their level of understanding.

• Prioritise Active Listening: Pay close attention to both what the patient says and how they say it. Their tone and hesitations might provide additional clues.

• Document Key Details: Record the patient's descriptions verbatim when possible. This helps ensure their experience is accurately captured.

• Adapt to Patient Comfort: If a patient seems uneasy, provide reassurance and adjust your questioning style to make them feel at ease.

Common Pitfalls

• Rushing Through Questions: Don’t move on to the next question without fully exploring the current one. A patient’s initial response might need probing for more details.

• Ignoring Non-Verbal Cues: Patients might not always articulate their pain well. Observe facial expressions, body language, and gestures for additional insight

• Overloading the Patient: Avoid asking multiple questions at once. Let each part of SOCRATES guide a separate conversation thread.

• Assuming Pain Origins: Do not infer the cause or type of pain prematurely; this might lead to misdiagnosis or oversight of key details.

• Failing to Clarify: Always confirm your understanding of the patient's description. Paraphrase their statements and ask if it aligns with their experience.

Tips for Learning and Remembering Socrates

• Practice with Role-Playing: Simulate patient interviews using SOCRATES with other students to build confidence and fluency.

• Create Flashcards: Use cards with each SOCARTES letter on one side and corresponding questions/examples on the other.

• Mnemonic Mapping: Develop a visual aid (e.g., a diagram of the body) linked to each SOCRATES aspect to reinforce memory.

• Incorporate Patient Scenarios: Think of real or hypothetical patient cases where the mnemonic applies, and work through them systematically.

• Repetition and Reflection: After every patient interaction, review how well you applied SOCRATES and identify areas for improvement.

Do This

When conducting pain anamneses, ensure you listen actively and empathetically to the patient, making them feel comfortable and understood. Use open-ended questions such as, "Can you describe the pain you are feeling?" to allow detailed responses. Encourage the patient to specify the pain's location, intensity, frequency, and duration, and note if it radiates to other areas. Use simple language that avoids medical jargon, ensuring clarity. Confirm details by paraphrasing what the patient has said to avoid misunderstandings. Always maintain eye contact, demonstrate interest through nonverbal cues, and document the patient’s responses accurately and thoroughly for reference.

Don't Do This

Avoid interrupting the patient or rushing through their explanations, as this may lead to incomplete information and feelings of disregard. Do not make assumptions about the pain based on preliminary impressions or stereotypes, as every patient's experience is unique. Refrain from using technical terms or complex medical language that might confuse or intimidate the patient. Avoid dismissing the patient’s concerns or downplaying their pain, as this could undermine trust and the effectiveness of the diagnosis. Lastly, never neglect to verify details or probe further if something seems unclear, as incomplete anamneses can result in misdiagnoses.

Exercises and Other Activities

• Anamnesis Phrases
• Medical Vocabulary
• Socrates
• Medical History Questionnaire
• Medical History
• Improve Your English with These Links
• The Socrates Acronym

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