Clinical thinking, at the bedside and beyond

Structured approaches to history-taking, systemic examination and clinical reasoning for the wards, practicals and viva.

A reliable history-taking framework

1. Presenting complaint(s), in the patient’s own words, with duration.
2. History of presenting illness — onset, course, character, aggravating/relieving factors, associated symptoms.
3. Relevant system review beyond the presenting complaint.
4. Past medical and surgical history.
5. Drug history, including adherence and over-the-counter or herbal use.
6. Family history, relevant to the presenting problem.
7. Personal and social history — occupation, habits (tobacco, alcohol), diet, functional status.

Presenting a case in this order every time builds a routine that holds up under exam pressure.

Systemic examination — general approach

Across systems, the same broad sequence keeps examinations complete and reproducible:

• General physical examination — vitals, pallor, icterus, cyanosis, clubbing, lymphadenopathy, oedema, and any obvious findings before approaching the patient.
• Inspection — from the end of the bed before touching the patient.
• Palpation, percussion, auscultation — in that order, as relevant to the system.
• Synthesis — summarise positive and relevant negative findings before offering a differential.

Building clinical reasoning

For each case, practice explicitly separating three steps: what you found, what it could mean (differential diagnosis, most likely to least likely), and what you would do next (investigation or management) and why. Examiners and seniors are usually more interested in your reasoning process than in a single “correct” answer.

Common case categories to be fluent in

This content is written for trainees and clinicians for educational purposes and is not a substitute for individualised patient care. See our Disclaimer.