Review of Systems - Evidenced Based?

[Guest guest]

I suppose this is mainly a Clinical question, but could also apply to Practice Mgt since it includes "risk management" (don't want to miss a basic ROS question that would miss major problems) and also Pract Mgt in the sense of what is the most efficient way to screen patients without taking up a lot of wasted time on questions that don't really matter.

Of course, I may be begging the question -- Do we really even need to do a Review of Systems - ever?

Sure, if the presenting complaint is headaches -- do a review of systems for that problem, but what about a general ROS.

I think there are some articles that suggest an "annual exam" isn't even recommended, so should we be doing complete ROS's?

Anyway, I'm thinking of updating the ROS form I use, but realized there are a gazillion questions that COULD be asked (hair loss?, itchy anus?, chapped lips? etc), but what are the questions that SHOULD be asked?

It would seem there are a list of questions that would give you the best bang for your buck.

Possibly -- blood in stool? Headaches? Abdominal Pain? Last Menstrual Period?

Questions that if positive -- have a hire likely hood of finding something serious that could be treated.

There are many questions which seem to have less bang for the buck.

Plus, we all have our favorite questions that give us insight to the patient.

One AAFP articles says that for HCFA, here are the "systems" that are recognized -- so from a coding standpoint, that would probably be a good breakout of areas to ask questions, but what are the questions to ask.

One could ask hundreds of questions, but what are the best?

The following systems are recognized for Review of Systems:

Constitutional symptoms (e.g., fever, weight loss),

Eyes,

Ears, nose, mouth, throat,

Cardiovascular,

Respiratory,

Gastrointestinal,

Genitourinary,

Musculoskeletal,

Integumentary (skin and/or breast),

Neurologic,

Psychiatric,

Endocrine,

Hematologic/lymphatic,

Allergic/immunologic.

Here is a list of ROS from a website.

http://medinfo.ufl.edu/year1/epc97/handouts/ros.html

Review of Systems

The following list illustrates the content of a complete review of systems.

General/Constitutional

Average weight, weight loss or gain, general state of health, sense of well-being, strength, ability to conduct usual activities, exercise tolerance

Skin/Breast

Rash, itching, pigmentation, moisture or dryness, texture, changes in hair growth or loss, nail changes

Breast lumps, tenderness, swelling, nipple discharge

Eyes/Ears/Nose/Mouth/Throat

Headaches (location, time of onset, duration, precipitating factors), vertigo, lightheadedness, injury

Vision, double vision, tearing, blind spots, pain

Nose bleeding, colds, obstruction, discharge

Dental difficulties, gingival bleeding, dentures

Neck stiffness, pain, tenderness, masses in thyroid or other areas

Cardiovascular

Precordial pain, substernal distress, palpitations, syncope, dyspnea on exertion, orthopnea, nocturnal paroxysmal dyspnea, edema, cyanosis, hypertension, heart murmurs, varicosities, phlebitis, claudication

Respiratory

Pain (location, quality, relation to respiration), shortness of breath, wheezing, stridor, cough (time of day, of productive, amount in tablespoons or cups per day and color of sputum), hemoptysis, respiratory infections, tuberculosis (or exposure to tuberculosis), fever or night sweats

Gastrointestinal

Appetite, dysphagia, indigestion, food idiosyncrasy, abdominal pain, heartburn, eructation, nausea, vomiting, hematemesis, jaundice, constipation, or diarrhea, abnormal stools (clay-colored, tarry, bloody, greasy, foul smelling), flatulence, hemorrhoids, recent changes in bowel habits

Genitourinary

Urgency, frequency, dysuria, nocturia, hematuria, polyuria, oliguria, unusual (or change in) color of urine, stones, infections, nephritis, hesitancy, change in size of stream, dribbling, acute retention or incontinence, libido, potency, genital stores, discharge, venereal disease

(Female) Age of onset of menses, regularity, last period, dysmenorrhea, menorrhagia, or metrorrhagia, vaginal discharge, post-menopausal bleeding, dyspareunia, number and results of pregnancies (gravida, para)

Musculoskeletal

Pain, swelling, redness or heat of muscles or joints, l;imitation, of motion, muscular weakness, atrophy, cramps

Neurologic/Psychiatric

Convulsions, paralyses, tremor, incoordination, parathesias, difficulties with memory of speech, sensory or motor disturbances, or muscular coordination (ataxia, tremor)

Predominant mood "nervousness" (define), emotional problems, anxiety, depression, previous psychiatric care, unusual perceptions, hallucinations

Allergic/Immunologic/Lymphatic/Endocrine

Reactions to drugs, food, insects, skin rashs, trouble breathing

Anemia, bleeding tendency, previous transfusions and reactions, Rh incompatibility

Local or general lymph node enlargement or tenderness. -Polydipsia, polyuria, asthenia, hormone therapy, growth, secondary sexual development, intolerance to heat or cold

Locke, MDBasalt, COEau (WI) Family Medicine Residency 19945 Years in Air Force -- [Laughlin AFB (Del Rio, TX) // Spangdahlem AB, Germany]Alpine Medical Group -- Private Group Practice since 1999www.alpinemedical.mdJob Share w/ WifeAMG went independent from hospital MSO 10/04AMG implemented Centricity EMR April 2005

AMG is dissolving Spring 2007

& Locke plan to set up Locke Family Medicine Spring 2007

www.LockeFamilyMedicine.com

[Guest guest]

Funny you bring this up now. I was just typing up my first annual

exam note in my new practice. I used Gordon's checklist as a

template and then was revising it for my own template. I was

thinking the same thing about all those ROS questions, what really

matters? It certainly does give insight into how a person perceives

their health (people who circle everything vs. nothing). Will be

interested to hear input from others.

Sharon

At 03:03 PM 1/3/2007, you wrote:

I suppose this is

mainly a Clinical question, but could also apply to Practice Mgt since it

includes " risk management " (don't want to miss a basic ROS

question that would miss major problems) and also Pract Mgt in the sense

of what is the most efficient way to screen patients without taking up a

lot of wasted time on questions that don't really matter.

Of course, I may be begging the question -- Do we really

even need to do a Review of Systems - ever?

Sure, if the presenting complaint is headaches -- do a review of systems

for that problem, but what about a general ROS.

I think there are some articles that suggest an " annual

exam " isn't even recommended, so should we be doing complete

ROS's?

Anyway, I'm thinking of updating the ROS form I use, but

realized there are a gazillion questions that COULD be asked (hair loss?,

itchy anus?, chapped lips? etc), but what are the questions that SHOULD

be asked?

It would seem there are a list of questions that would give

you the best bang for your buck.

Possibly -- blood in stool? Headaches? Abdominal Pain?

Last Menstrual Period?

Questions that if positive -- have a hire likely hood of

finding something serious that could be treated.

There are many questions which seem to have less bang for

the buck.

Plus, we all have our favorite questions that give us insight to the

patient.

One AAFP articles says that for HCFA, here are the

" systems " that are recognized -- so from a coding standpoint,

that would probably be a good breakout of areas to ask questions, but

what are the questions to ask.

One could ask hundreds of questions, but what are the best?

The following systems are recognized for Review of Systems:

Constitutional symptoms (e.g., fever, weight loss), Eyes, Ears, nose, mouth, throat, Cardiovascular, Respiratory, Gastrointestinal, Genitourinary, Musculoskeletal, Integumentary (skin and/or breast), Neurologic, Psychiatric, Endocrine, Hematologic/lymphatic, Allergic/immunologic.

Here is a list of ROS from a website.

http://medinfo.ufl.edu/year1/epc97/handouts/ros.html

Review of Systems

The following list illustrates the content of a complete review of

systems. General/Constitutional

Average weight, weight loss or gain, general state of health, sense

of well-being, strength, ability to conduct usual activities, exercise

tolerance Skin/Breast

Rash, itching, pigmentation, moisture or dryness, texture, changes in

hair growth or loss, nail changes Breast lumps, tenderness, swelling, nipple discharge Eyes/Ears/Nose/Mouth/Throat

Headaches (location, time of onset, duration, precipitating factors),

vertigo, lightheadedness, injury Vision, double vision, tearing, blind spots, pain Nose bleeding, colds, obstruction, discharge Dental difficulties, gingival bleeding, dentures Neck stiffness, pain, tenderness, masses in thyroid or other areas Cardiovascular

Precordial pain, substernal distress, palpitations, syncope, dyspnea

on exertion, orthopnea, nocturnal paroxysmal dyspnea, edema, cyanosis,

hypertension, heart murmurs, varicosities, phlebitis, claudication Respiratory

Pain (location, quality, relation to respiration), shortness of

breath, wheezing, stridor, cough (time of day, of productive, amount in

tablespoons or cups per day and color of sputum), hemoptysis, respiratory

infections, tuberculosis (or exposure to tuberculosis), fever or night

sweats Gastrointestinal

Appetite, dysphagia, indigestion, food idiosyncrasy, abdominal pain,

heartburn, eructation, nausea, vomiting, hematemesis, jaundice,

constipation, or diarrhea, abnormal stools (clay-colored, tarry, bloody,

greasy, foul smelling), flatulence, hemorrhoids, recent changes in bowel

habits Genitourinary

Urgency, frequency, dysuria, nocturia, hematuria, polyuria, oliguria,

unusual (or change in) color of urine, stones, infections, nephritis,

hesitancy, change in size of stream, dribbling, acute retention or

incontinence, libido, potency, genital stores, discharge, venereal

disease (Female) Age of onset of menses, regularity, last period,

dysmenorrhea, menorrhagia, or metrorrhagia, vaginal discharge,

post-menopausal bleeding, dyspareunia, number and results of pregnancies

(gravida, para) Musculoskeletal

Pain, swelling, redness or heat of muscles or joints, l;imitation, of

motion, muscular weakness, atrophy, cramps Neurologic/Psychiatric

Convulsions, paralyses, tremor, incoordination, parathesias,

difficulties with memory of speech, sensory or motor disturbances, or

muscular coordination (ataxia, tremor) Predominant mood " nervousness " (define), emotional

problems, anxiety, depression, previous psychiatric care, unusual

perceptions, hallucinations Allergic/Immunologic/Lymphatic/Endocrine

Reactions to drugs, food, insects, skin rashs, trouble breathing Anemia, bleeding tendency, previous transfusions and reactions, Rh

incompatibility Local or general lymph node enlargement or tenderness. -Polydipsia,

polyuria, asthenia, hormone therapy, growth, secondary sexual

development, intolerance to heat or cold Locke, MD

Basalt, CO

Eau (WI) Family Medicine Residency 1994

5 Years in Air Force -- [Laughlin AFB (Del Rio, TX) // Spangdahlem AB,

Germany]

Alpine Medical Group -- Private Group Practice since 1999

www.alpinemedical.md

Job Share w/ Wife

AMG went independent from hospital MSO 10/04

AMG implemented Centricity EMR April 2005

AMG is dissolving Spring 2007

& Locke plan to set up Locke Family Medicine Spring

2007

www.LockeFamilyMedicine.com

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Sharon McCoy , M.D.

Renaissance Family Medicine

The

Rebirth of Personal Healthcare

www.SharonMD.com

Phone Fax (949)

281-2197

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