Responding to symptoms pharmacy mnemonics are popular in community pharmacist. A pharmacist may have to diagnose common minor ailments for patients who present them with health complaints, and respond to their symptoms on the spot. Some of these patients may not have a history at the pharmacy, and pharmacists have to judge what the best way to care for the patient is in front of them, and find out more about the situation. To do this, there are different sets of questions that can be asked, and most pharmacy students are taught to remember particular mnemonics to aid them.

With so many different mnemonics however, which one of these is the most beneficial for finding out the necessary information?

WWHAM

  • Who is the presenting complaint about? (patient or other)
  • What are the symptoms present?
  • How long have the symptoms been present?
  • Action already taken?
  • Medication being taken?

This is the most basic method of questioning used by pharmacists. Whilst it is direct, and asks most of the necessary questions, it is broad and requires the pharmacist to delve deeper to find out more about the problem. It does not allow the patient to provide information about potential allergies or specific information about the symptoms. WWHAM is a solid starting point for questioning, but if the patient does not provide enough information, then other methods of questioning may also be required to put into practice.

ASMETHOD

  • Age/appearance of patient
  • Self or someone else?
  • Medication currently taken?
  • Extra medication/herbal/supplements
  • Time symptoms have been present
  • History (medical/social/family)
  • Other symptoms
  • Dangerous symptoms

This mnemonic questions more about the patient themselves, and how they ‘appear’ so it is easier to diagnose based on observing the patient. It also allows the pharmacist to ask if there are other medications being taken that a patient may have forgotten about, such as herbal medications, or any supplements that could potentially cause interactions. As well as this, the history of the complaint can be mentioned, which can allow the patient to provide a lot of detail about their case. This method focusses heavily on the symptoms themselves, and takes into account how the patient is feeling as a whole, which allows for a thorough diagnosis.

SITDOWN SIR

  • Site of symptoms
  • Intensity of symptoms
  • Type/nature
  • Duration
  • Onset
  • With (any other symptoms)
  • Aggravated by?
  • Spread of symptoms?
  • Incidence of symptoms?
  • Relieved by?

SITDOWN SIR is the longest mnemonic, but this does not necessarily allow it to be the most efficient in finding out information. Though it focusses mainly on the symptoms, and asks more specific questions, it does not ask about any medication that the patient takes, any allergies, or who is suffering from the symptoms, which is perhaps the most important initial question. It should therefore be used in combination with another mnemonic, perhaps WWHAM, as these together would cover most of the necessary information needed to respond to the symptoms presented.

ENCORE

  • Explore the case
  • No medication?
  • Care already given?
  • Observe patient
  • Referral needed?
  • Explain to patient

This final questioning technique is again broader, and is usually used at the end of a consultation in the event of more severe cases. It also explores the possibility of a patient being ‘referred’, and allows information to be explained to the patient at the end of the consultation, which is useful for the patients themselves, so they understand what the next steps to be taken are.

Out of the four different techniques, ASMETHOD is the one that has the most potential in exploring the case of the patient, and is the most specific with regards to questioning, as it covers the most ground. WWHAM, SITDOWNSIR and ENCORE however, all have components which could be incorporated into questioning as well. It is very important that the entire case is taken into consideration for each patient, and that their current medication, allergies, and other herbal medication/supplements are also investigated as well as their symptoms. Finally, the best way to end a consultation such as this is to explain to the patient specifically what the outcome is, and make sure they understand fully so they know what to do next.

Neela Kumar – 2nd year Pharmacy student

Reference

Resourcepharm.com accessed on 13/10/2013