Building a health history: communication and risk tools

Three patient profiles are printed together and exactly one of them is yours, allocated by the first letter of your surname. That is the first thing to get right and the easiest thing to get wrong, because the profiles sit side by side in the brief and the preparation bullets ask how your techniques would differ *with each patient*. Those bullets are thinking prompts; the posting instruction that follows is singular throughout — your assigned patient, the instrument you selected, the five questions you would ask them. A post covering all three is not more thorough, it is off task, and it will be visibly shorter on the one patient that mattered. Check the allocation before drafting rather than after, because the profile you write about is not something that can be fixed by editing. If the announcement naming your profile has not appeared yet, wait for it rather than guessing from the letter ranges.

Each profile carries a different obstacle, and the communication techniques you name should answer that obstacle rather than being good practice in general. The 26-year-old Lebanese woman in graduate-student housing raises questions about language preference, whether cultural or religious considerations affect discussion of reproductive and sexual health, and the access problems of a student. The 14-year-old living with his grandmother needs the adolescent confidentiality conversation — time alone without the accompanying adult, and an explicit statement of what you can and cannot keep private — plus attention to who holds legal decision-making authority when the caregiver is a grandparent rather than a parent. In both cases the technique follows from a fact in the profile, which is the connection the instruction is asking you to make explicit. Grandparent caregivers frequently lack formal custody, which changes who may consent, so it is worth establishing early rather than discovering mid-interview.

The 38-year-old pregnant woman living on a reservation raises distance and access to prenatal care, the practicalities of Indian Health Service coverage, and a well-documented history of mistrust between Native communities and the health system that has to be met with something more considered than reassurance. In each case, name the technique and say what it is for: open-ended questioning to avoid leading a patient who may be guessing what you want to hear; teach-back where comprehension matters; a professional interpreter rather than a family member where language is an issue; and explicit permission-seeking before sensitive topics. The instruction says explain **why** you would use these techniques, and the why is the profile. Naming the purpose beside the technique is what converts a list of good communication habits into a defence of choices made for this person.

*How might you target your questions based on the patient's social determinants of health* is the clause that decides whether your five questions land. Targeted means the question could not sensibly be asked of the other two profiles. Do you smoke is not targeted; asking the 14-year-old who is at home after school and whether he feels safe on the walk there is. Asking the pregnant woman how far her prenatal appointments are and how she gets to them is. The recognised domains give you the material: housing stability, food security, transportation, utilities, interpersonal safety, income and social support. Five questions drawn from those domains, phrased for one specific person, is exactly what is being asked for. Phrase them as you would actually say them, since a question written in clinical shorthand is not a question the patient could answer.

The instrument has to be justified for this patient and the usual failure is age validity — reaching for a screening tool developed and validated in adults and applying it to a fourteen-year-old. Say what population the tool was validated in, what it screens for, and how you would act on a positive result, because an instrument with no consequent action is a questionnaire. A standardised social risk screening tool is a legitimate choice here given how heavily the brief leans on social determinants, and it has the advantage of being designed for exactly this purpose. Finally, the post asks for a summary of the interview as well as the analysis, so write the summary as though the conversation happened rather than describing what you would do. Writing it as a summary rather than a plan also makes the five questions read as things that were asked, which is the framing the post is looking for.