Patient History and Interviewing
Structure the interview
Begin open-ended: "What brings you in today?" Record the chief complaint in the patient's own words, then funnel toward specifics. Organize the history of present illness with OPQRST (onset, provocation/palliation, quality, region/radiation, severity, timing) plus functional impact. Follow with past medical and surgical history, medications and supplements (with doses), allergies, family history, social history (occupation, lifting, tobacco, alcohol), and a targeted review of systems.
Screen, do not merely collect
Every history includes a red-flag screen: bowel or bladder dysfunction, saddle anesthesia, progressive weakness, unexplained weight loss, night pain that wakes the patient, fever, cancer history, significant trauma, injection drug use, immunosuppression, and new pain after age 50. Ask directly; patients rarely volunteer these. Capture baseline outcome measures (numeric pain rating, Oswestry, NDI, PEG) so later comparisons mean something.
Traps
Leading questions ("Does it shoot down the leg?") manufacture findings. Accepting "same as last time" without re-screening misses new pathology. Copying another clinician's diagnosis into your history section blurs attribution-label it as reported. Forgetting to ask about anticoagulants or recent corticosteroid use matters before any manual therapy.
Worked example
A 56-year-old woman reports new mid-thoracic pain after lifting a light box. Asked directly, she discloses a breast cancer history five years ago and pain that wakes her at 2 a.m. Those two red flags redirect the plan toward imaging and medical co-management before any thrust technique-no matter how mechanical the pain feels.