What You Should Know About the Chief Complaint

dealing with doctors medical interview patient advocacy rare care rare disease rare disease patient

If you have been seen at a teaching hospital you have likely been seen by a medical student or resident prior to seeing the (attending) doctor. They meet with you first and their job is to take your history and present it to the doctor. Sometimes it goes well but too often it ends up a bit like a game of telephone where your original message is distorted and garbled when it gets to the doctor.

Let's look at one aspect of what is going on here and why things sometimes go awry.

Chief Complaint

Have you ever thought about the process or framework a doctor uses to get information from you in an interview? Did you know that they are all taught this framework, the medical interview, in medical school and they continue to use it throughout their career?

One of the most important components of the medical interview is the chief complaint. The chief complaint is used by the doctor to structure the appointment and informs what questions he asks and the physical exam that is needed.

chief com·plaint (cc, c.c., C.C.),
the primary symptom that a patient states as the reason for seeking medical care.
chief complaint. (n.d.) Farlex Partner Medical Dictionary. (2012).

Interestingly, it is also used for medical coding and has a more comprehensive definition. So the chief complaint is used for billing purposes and can include conditions, diagnosis, symptom or problem. This definition comes from AAPC, American Academy of Professional Coders. For coding purposes, multiple issues can be coded as the chief complaint to signify the complexity and to increase billing amounts.

Each time you meet with a patient, you should document a chief complaint (CC). CPT defines the CC as “A concise statement describing the symptom, problem, condition, diagnosis, or other factor that is the reason for the encounter, usually stated in the patient’s words.” Simply stated, the chief complaint is a description of why the patient is presenting for healthcare services.

When you call for an appointment, get checked-in and while talking to the medical assistant or nurse, they are trying to identify the chief complaint or why you are there. In some cases, like getting checked for strep throat it is very clear and easy to identify - the chief complaint is a sore throat.

With rare diseases and complex health problems, it can be harder to narrow it down to a clear chief complaint. More about this later and how you can deal with aspect when you have multiple symptoms and numerous issues.

What it is used for?

The doctor uses what they identify as the chief complaint as the priority of the appointment and then focuses their line of questioning and physical exam on it. Remember, they have a specific format for the appointment so they will be asking questions within a framework to work toward a diagnosis and/or treatment.

There are several mnemonics used to help them remember what questions or topics should be covered to better understand the chief complaint. Some of the mnemonics and their areas of questioning are listed below.

SOCRATES - Site, Onset, Character, Radiation (if the symptom is discomfort or pain), Alleviating factors, Timing, Exacerbating Factors, Severity
OLD CARTS - Onset, Location/radiation, Duration, Character, Aggravating factors, Reliving factors, Timing and Severity

What does this mean for a rare disease or complex patient?

If you are anything like me, I seldom have only one symptom or even one issue to be discussed at an appointment. But when we come in with multiple issues or when we aren't prepared to answer the type of clarifying questions listed above, we can make it harder for the doctor to get a clear picture of our issues, causing some doctors to be frustrated and leading to less than optimal care.

I know that there were times that I was so anxious to share information that I interrupted the doctor while they were taking our history. They were busy working through their process to identify and address the chief complaint but I didn't realize that I was interrupting their thought process and making their job harder than it had to be.

What can we do to help?

1. Identify and think through your chief complaint

Realistically, you can only talk about and address one or maybe a couple of issues maximum. Prior to the appointment, think about what is the most important thing you would like addressed. It doesn't necessarily mean only one symptom, it can be a group of symptoms but it should be one issue.

2. Be prepared to discuss the details related to your chief complaint

It can be easy to forget specific details on your issues. Take some time and think through the types of questions that the doctor is likely to ask such as how long it lasts, where it is, when it started, a detailed description of it, the severity, what it makes it better or worse. Check out the links above for more explanations about the types of information your doctor is looking for.

3. Create a written, prioritized list of issues and symptoms

Knowing that we are likely to have more than one issue that needs to be addressed, especially with specialists, who we only see occasionally, it can help to create a prioritized list of your issues. Include symptoms and any details that would help them in their questioning. By providing a written list, it allows the doctor to take in more information and assess what is important for them to pursue in their questioning. The written document not only provides a clear summary, but it also prevents the entire appointment being spent with us trying to verbally share our issues, symptoms, and concerns.

Need some help organizing your issues and symptoms for your next appointment? Check out our free Rare Disease Appointment Planner Here.