Case History and Patient Communication
Opening the consultation
Begin with an open, non-leading invitation ("Tell me what has brought you in today") and let the patient finish before narrowing. Convert the complaint into a structured history: onset, duration, character, severity, associated symptoms, modifying and aggravating factors, and previous episodes. Follow with past ocular history (spectacles, contact lenses, surgery, trauma, amblyopia), systemic health (diabetes, hypertension, autoimmune disease, pregnancy), a full medication list including drops and herbal remedies, allergies, family history of glaucoma or retinal disease, and social or occupational factors such as driving, screen use, smoking and hobbies.
Communication skills examiners reward
Active listening, signposting ("I would now like to ask about your general health"), plain-language explanation with teach-back, summarising before examination, and explicit consent before any procedure. Empathy should be specific rather than formulaic. When breaking unwelcome news, use a staged approach: prepare, establish what the patient already knows, invite questions, warn before disclosing, then check understanding and agree a plan.
Traps
Leading or closed questions that suggest the answer; anchoring on a diagnosis the patient has already suggested; premature closure once a plausible cause appears; accepting "just a little blurry" without quantification; failing to document pertinent negatives; and using jargon. Missing red flags - sudden painless visual loss, flashes or floaters, a curtain or shadow, halos, transient visual loss, trauma - is the commonest critical failure.
Rule of thumb
Apply a two-question check to any symptom before moving on: "What makes it worse?" and "What makes it better?" If the answers remain vague, the history is not finished.