GRIPS

○ First presentation
G – GREAT the patient: Hello… wait for the answer … Hello.
R – RAPPORT
I – INTRODUCE yourself:
- My name is Dr. Ahmed Mohamed
- I’m one of the junior doctors in this department/surgery
- Are you Mr. James Brown? / May I know your name?
- What can I call you?
- Would you confirm your age for me please?
P – PURPOSE of consultation: How can I help you?
S – SMILE
○ Follow up / Admitted patient
G – GREAT the patient: Hello… wait for the answer … Hello.
R – RAPPORT
I– INTRODUCE yourself:
- My name is Dr. Ahmed Mohamed
- I’m one of the junior doctors in this department/surgery
- Are you Mr. James Brown? / May I know your name?
- What can I call you?
- What’s your relationship to Mr. Eliot Jones (If you’re talking to a relative)
P – PURPOSE of consultation:
Paraphrase
- I understand that you are here for follow up
- I understand you have been admitted to hospital for the last 5 days
- I understand you had some blood tests/investigations done
Prior understanding
- Has anyone explained those investigations to you?
- What have you been told about your condition so far?
- Has anyone explained your father’s condition to you?
- Can you tell me what has happened so far, so that we both
understand the same thing?
Purpose of consultation
- I’ve been asked to come and talk to you about your condition and
address any concerns you might have
- I’ve been asked to come and explain the result of your investigations
to you
S – SMILE
HISTORY TAKING (Focused History)
○ Presenting Complaint
SOCRATES (for pain)
S – Site: Where is the pain? Can you show me where the pain is?
O – Onset: Did the pain start suddenly or gradually?
C – Character: What type of pain is it? (Dull ache/compressing/sharp)
R – Radiation: Does the pain go anywhere else?
A – Associated symptoms: Differential diagnoses
T – Timing: Is there any specific time you experience this pain? Does it
come and go?
E – Exacerbating and relieving factors: Is there anything that makes the pain
worse? Is there anything that makes the pain better?
S – Severity/Score: On a scale of 0 – 10, 0 being no pain and 10 being the
worst pain, how would you score your pain?

FODPARA (for other symptoms)

F – Frequency: Is it the first time you have this? How often do you have this?
O – Onset: Did it come on suddenly or gradually?
D – Duration: When did it start?
P – Progression: Is it getting worse or improving or is it the same?
A – Aggravating factors: Anything that makes it worse?
R – Relieving factors: Anything that makes it better?
A – Associated symptoms: Differential diagnoses
 Differential Diagnosis
 Systemic review
CVS: Chest pain – SOB – Dizziness – Palpitation – Ankle oedema – Orthopnea
GIT: Appetite – Weight loss/gain – Abdominal pain – Nausea – Vomiting –
Diarrhoea – Constipation – Haematemesis – Indigestion
CNS: Headache – Numbness – Weakness – Seizures – Problem of vision –
Hearing problem – Dizziness
Respiratory: Cough – Phlegm – Hemoptysis – Wheezes
Genitourinary: Pain during urination – Hematuria – Incontinence – Hesitancy –
Discharge – Nocturia – Terminal dribbling – Dyspareunia
Musculoskeletal: Joint pain - Rash
 Risk factors
 Red flags
○ P3MAFTOSA
P – Presenting Complaint: At the beginning …
P – Past Medical History: Let’s talk about your general health …
- Do you have any medical conditions?
- Have you ever been admitted to hospital for any reason?
- Have you ever had any operations performed on you?
- Do you have any medical conditions like (relevant conditions)?

P – Personal History: (Sexual history – Menstrual history - Drug abuse)

○ Sexual History
I need to ask you a few personal questions about your sexual life to get a
better understanding of your condition, if you feel uncomfortable at any
time please let me know…
Sexual practice
- Are you sexually active?
- Is your partner male or female?
- Do you practice safe sex? By this, I mean do you use condoms?
- What kind of sexual intercourse do you usually practice?
(Oral/vaginal/anal)
- When was your last sexual intercourse?
- Have you ever had sexual intercourse for casual purposes?
- Have you travelled abroad?
- If yes, is there any chance you could have sexual intercourse while
you were abroad?
Relationship
- Are you in a stable relationship?
- Are you married?
Previous infections and testing
- Have you ever had a sexually transmitted infection?
- Have you ever been tested for sexual transmitted infections?
(HIV/Chlamydia/Gonorrhoea)
Symptoms
- Are you experiencing any discharge from your private parts
(Penis/Vagina)?
- Any burning sensation when passing urine?
- Have you noticed any ulcers or lumps in your private area?
- Are you running any temperature?
Partners
- Is there any chance you could have any other partner?
- How many partners did you have in the past 6 months?
- Is your partner experiencing any symptoms such as discharge from
the private parts, pain, or lumps anywhere?
Tracing contact
- Did you have sexual intercourse with your partner after that?
- What kind of sexual intercourse did you have with your partner?
- Is there any chance you could have sexual intercourse with anyone
else after that?

○ Menstrual History:
- When was your last menstrual period?
- Are your periods normally regular?
- How many days do you bleed?
- How many days is your menstrual cycle?
- Do you pass any clots?
- Are your periods painful?
- Are your periods heavy?
- When was your last cervical smear?
- What was the result of your last cervical smear?
- Do you use any type of contraception?
- If yes, which contraception are you using?

○ Drug Abuse History:

Recreational drugs
- Is there any chance you use recreational drugs?
- What kind of drugs do you use?
- How do you take these drugs? (Smoke/Inhale/Inject/Sniff)
- For how long have you been taking them?
- Do you use any other drugs?
- Who do you do drugs with?
- If you stop taking these drugs, do you develop any withdrawal
symptoms?
- If yes, what kind of symptoms do you usually develop?
- Have you ever attempted to stop using recreational drugs?
Safeguarding issues/Social services
- Who else is at home?
- Do you use drugs at home?
- Are there any children at home?
- Do you ever take drugs in front of your children?
- Have the social services ever been involved in your children?
Needles
- Do you use needles?
- If yes, do you share needles with other people?
- Do you know about needle exchange program?
- This is a program in which people who use needles for drugs after
they use the needles and syringes, they have to bring it back to
addiction clinic and they give them new needles and syringes, but if
you do not bring back the used ones, so you aren’t given the new
ones, the program is aimed at stopping the spread of HIV and
Hepatitis which are mainly spread through sharing needles and
syringes with other people.
- Do you use the needle exchange program?
- If no, is there any particular reason you don’t use the needle
exchange program?
Social History
- Where do you get drugs from?
- What do you do for your living?
- How to you get money to buy drugs?
- Have you ever been in problems with the law?
- Do you have any siblings?
- Are your parents around?
- Do they know you use recreational drugs?
- How does your family feel about you using drugs?
- Would your family or partner be supportive of you while trying to stop
using recreational drugs?
- Does your partner use recreational drugs?

M – Medication History:
- Are you taking any regular medication?
- Are you taking any over the counter (OTC) medication?
- Are you on any type of contraception (for females of reproductive age
only)?

A – Allergy History:
- Are you allergic to anything?
- Are you allergic to any medication?
- If yes, what happens when you take it?

F – Family History:
- Is there anyone in your family with similar condition?
- Is there anyone in your family with (Relevant condition)?

T – Travel History:
- Have you travelled abroad recently?
- If yes, where did you travel?
O – Occupation History:
- What do you do for a living?
- If retired, what did you use to do for a living?

S – Social History: Let’s talk about your social life…

 Accommodation:
- Who do you live with?
- Are you married? Do you have any children?
- Do you live in a house or a bungalow?
- Do you walk independently? (For elderly patients or patients with
disabilities)
 Stress:
- Is there anything that is causing you stress in your life?
 Smoking:
- Do you smoke?
- If no, have you ever smoked?
- If yes, for how long? How many cigarettes per day?
 Alcohol:
- Do you drink alcohol?
- If yes, How many units per week?
 Exercise:
- Are you physically active?
 Diet:
- What kind of diet do you have?

A – Anything else:
- Is there anything else you would like to tell me about your condition?
○ ICE
I – Ideas:
- Is there anything you feel could be the cause of your symptoms?

C – Concerns:
- Is there anything you are worried about?

E – Expectation:
- at the end of the consultation

○ Effects of Symptoms
○Social life effects
- How has this affected you?
- Has it affected your sleep?
- Has it affected your daily activity?
- Has it affected your work?
- Has it affected your relationship?
- What does your partner think about this?
- Is your partner supportive?
- What do you do in your free time?
- Has it affected your hobbies?
- Does this stop you from doing that?
○Psychological effects
- Does this cause you any anxiety?
- How is your mood, on scale from 1 to 10, 1 being the lowest and 10
being the highest?

○ Summarise
Let me go through everything you have told me so far, to make sure I have
understood correctly. So…SUMMARISE HISTORY…Is there anything I
missed?
EXAMINATION
○ Observations:
I’d like to check your vitals, I mean your BP – Pulse – Oxygen – RR – Temp

○ Specific Examinations: (Inspection – palpation – percussion – auscultation)

I’d like to examine your … Is that okay with you?
- Chest examination your heart and lungs
- Abdominal examination your tummy
- ENT examination your ear, nose and throat
- Eye examination your eyes
- Neurological examination your nerves
- Leg examination your legs
- Per rectal examination your back passage
- Head to toe examination your whole body

○ Bed-side tests: We need to do a …

- Urine dipstick
- Urine Pregnancy test
- ECG
- Capillary Blood glucose (BM)
- CTG

PROVISIONAL DIAGNOSIS
From what you have told me so far (History) and after examining you
(Explain the findings), UNFORTUNATELY, I suspect that you may have what we
call (Provisional Diagnosis).

PAUSE
EXPLAIN DIAGNOSIS / INVESTIGATION LEADING TO DIAGNOSIS
It is a (Define the diagnosis). But we need to confirm that by carrying out
some investigations.
MANAGEMENT
○ Routine investigations:
We need to run some routine blood tests such as FBC (to check your blood
levels) – U&E – LFT (to make sure that your kidneys and liver are working
properly and to check the electrolytes) – Blood sugar – ESR – CRP (which
are the inflammatory markers)

○ Treatment
- If confirmed, then we’ll give you…

○ Decision (Admission – Discharge – Referral)

○ Safety netting
- Please come back (or call 999) if you develop …

○ Follow up
- Otherwise, I’d like to see you again after … to review your condition.

○ Leaflets
- Before you go, I’ll bring you a leaflet about …

○ Summarise
- Let us recap what we have discussed…SUMMARISE MANAGEMENT.

○ Expectations
- What do you think about what we have discussed?
- Do you have any questions from what I’ve told you?
- Is there anything else I can do for you?
●Examples for acknowledging concerns (Patient may ask questions before taking history)
Pt: Do you think it can be cancer?
I need to ask you some questions before I can say whether there is a
possibility of cancer or not. But you seem to be concerned about cancer, is
there any particular reason why you are worried about cancer?

Pt: Do you think it’s something serious?

I would like to ask you some questions before I can say whether there is a
possibility of something serious. Is there anything you are worried about?

Pt: Doctor, I need an urgent referral

Sometimes urgent referrals are necessarily. But I would like to ask you
some questions to see what kind of referral is needed and possibly which
specialist you need to see. What makes you feel that you need an urgent
referral?

Pt: Doctor, I need a CT scan of the brain

I would like to ask you some questions to see whether you need a CT scan
and what type of CT scan you need.

Pt: Doctor you are asking me about family history of cancer, do you
think it is cancer.
Cancer is one of those things that we need to rule out, but I would like to
ask you some questions before I can say whether there is a possibility of
cancer.

Pt: Doctor, can we see our son? Can we see him now?
You will be able to see your son, but I would like to check some information
first.

Pt: How is my husband/son/wife?

Unfortunately, he is not doing very well at the moment, but I would like to
ask you some questions before we go into details.
● Responding to emotions Use EVE Protocol
E– Explore Emotions (Body language/Verbal language)
- I can see that you look a little bit upset/worried/disappointed
- I can see that you didn’t expect this
then…PAUSE…

V– Validate Emotions
- I can understand why you are upset/worried/disappointed, anyone
would be upset/worried/disappointed with what has happened

E– Empathic Response
- I am sorry for what you have been through
- I am sorry for what has happened
- I am sorry to hear about your dad

● Language for discussing management involving the patient

- It is highly recommended…
- It is advisable…
- What if we try and help you by…?
- Is there any particular reason why you cannot stay in hospital? … then
look for solutions … would that be acceptable for you?
- Are you ok with that?
- What do you think about that?

● Language for being sensitive

- Unfortunately, …
- I am sorry to tell you that …
- Sadly, … (Very strong)

● Language for being polite

- Please, …
- Thank you (when the patient/examiner gives you findings)
- Thank you very much, it was nice meeting you. I’ll see you next time.

● Referral types
- Emergency/Immediate referral: now or within 24 hours
- Very urgent referral: within 1-3 days (e.g., Rheumatoid Arthritis)
- Urgent referral: within 2 weeks (e.g., suspected cancer)
- Routine referral: up to 18 weeks (get their appointment by post within 28 days)