|The doctor sees the problem in simplistic terms, seldom taking into account important things such as life events, stress, risk factors or even intercurrent illness.||The doctor incorporates into the analysis of the problem what he/ she knows of the patient’s life and background, and uses the records so that he/she defines the problem in physical, social and psychological terms.|
|Has little understanding of this.||Attempts to do this but is not yet skilful and sometimes runs into difficulty.||Attempts to do this and is usually successful but recognises his/her limitations.||Perfect|
|(a)||Includes causal factors (eg smoking or family history), contributory factors (eg, obesity), and associated factors (eg marriage break-up or job loss) and seeks to answer the questions: “Why him?”, “Why now?”.|
|(b)||Takes into account any other disease that the patient is known to have, or be at risk (eg in diabetes remembers the association with other autoimmune diseases, or in arthritis remembers a previous history of peptic ulcer).|
|(c)||Shows ability to extract information from the clinical records.|
Notes for raters
This area of behaviour is best assessed in case discussion and tutorials, byprobing the depth to which the patient’s problems have been considered.