Table 1.

Taking a history

Task	Suggested questions and approach
Elicit symptoms	Start with open questions to elicit symptoms: Tell me about the problems or symptoms? Where there are many symptoms, by asking which symptom or symptoms are the worst can help to focus a history (eg ‘If you could take one symptom away which would it be?’) Then move to more specific questions What and where are the symptoms? How long have they had them? When do they occur? Do they fluctuate? What else happens? Are there associated symptoms? What brings them on? What makes them better? What makes them worse? Ask about commonly seen associated symptoms: fatigue, pain and poor sleep. Do they avoid things that could bring on the symptoms? Is there a boom and bust pattern to the symptoms?
Triggers	Did anything bring these symptoms on? Did you have any illnesses or health problems when the symptoms first came on? Were there any stressful things or big changes in your life around the time the symptoms started?
Physical and mental health screening	Ask about red flag symptoms as you would do for anyone with physical symptoms. Ask about depression, anxiety and stress: How has this affected your mood? If their mood is low: Which do you think came first? It's common for people with physical symptoms like yourself to feel low or worried; has that happened with you?
Impact	How has this affected you? Are there things you've had to stop doing? Think about the impact on different areas of life. Work/education Social life and relationships Home life, everyday tasks and activities of daily living Mobility and limits on what they can do? At the most severe end, are they largely housebound or even bedbound? Asking the patient to describe a typical day can be helpful, particularly to get a sense of what they are actually doing. Significant others; do they have a caring role? Do they have other support? Are there any potential reinforcing factors?
Sleep	Has this affected their sleep? Detail here can help with the advice you give on sleep hygiene later. What time they go to bed and time they fall asleep. The number of times they wake up in the night and how long. What time they wake up in the morning and time they get up. If they take daytime naps.
Current medication	Both prescribed and non-prescribed/over-the-counter medication. Are they using any regular pain relief?
Past medical and psychiatric history	Long-term conditions and past illness. Childhood illness. History of mental health problems. Also ask about interventions for their physical symptoms: cognitive behavioural therapy or other talking therapies, medication, medical procedures and alternative treatments. What has been tried so far? Did it help?
Family history	Has anyone in your family had similar symptoms? Has anyone in your family had other physical symptoms that lasted a long time? Ask if there are any other long-term conditions or mental health conditions in close family members, including things that occurred in the patient's childhood.
Social history	Employment, education, housing/living arrangements, welfare and benefits.
Drugs and alcohol	Is there any use of alcohol or recreational drugs, particularly to help alleviate the symptoms? Are opiate painkillers being used, either prescribed or non-prescribed?
Personal history	Childhood adversity/illness, parental ill health, history of traumatic events and attitude to illness in family.