Case History and Patient Interview
Why the history carries the case
Most musculoskeletal diagnoses are suggested by the history alone; examination and imaging usually confirm rather than discover. Structure the interview with open-ended questions first and narrow later (the funnel technique). Record the chief complaint in the patient's own words, then expand with OPQRST - onset, provocation/palliation, quality, region/radiation, severity, and timing - plus a targeted review of systems.
Screen systematically for red flags: unexplained weight loss, night pain unrelieved by positional change, fever or chills, prior cancer, significant recent trauma, progressive neurologic deficit, bowel or bladder dysfunction, saddle anesthesia, and new complaints in patients over 50. Medication history changes management directly: anticoagulants, corticosteroids, and bisphosphonates all bear on the manipulation decision. Ask about prior chiropractic care, surgeries, family history, occupation, smoking, and alcohol, because each shifts pretest probability.
Traps
Leading questions ("Does it shoot down your leg?"), accepting a diagnosis the patient arrives with, recording the patient's opinion as a finding, and never asking what the patient wants out of care.
Rule of thumb
Constant, nocturnal thoracic pain in a patient over 50 that is unrelated to movement is malignancy or infection until proven otherwise - image before any thrust procedure. Separate subjective report from objective finding in the note, and document that informed consent was discussed.