On a Scale From Zero to Ten

When the patient rates the intensity of [pain, depressed mood, anxiety or other symptom] the number means nothing without a reference point. I advocate adding “where ten represents the worst you ever experienced the symptom and zero represents complete absence of the symptom.”

If you leave it all to the patient’s imagination, ten can represent almost anything, but if ten represents the worst ever, you then ask for a description, and you can follow with questions about when they last experienced a ten, associated circumstances, and how often the symptom was that bad in the past. Also ask the patient to rate the best their symptoms have been and when was the last time they were completely free of symptoms.

Then and only then will you have a complete history.

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