Patient History and Interviewing
What the exam tests
The history station evaluates whether you can obtain a complete, organized history and respond to patient cues within a time limit. You are scored on the questions you ask, the order you ask them in, and the empathy you show while asking.
Core structure
Open with an open-ended invitation ("What brings you in today?") and let the patient finish. Then use OLDCARTS for the chief complaint: Onset, Location, Duration, Character, Aggravating and Associating factors, Relieving factors, Timing, Severity. A complete ocular history covers the last complete eye exam, refractive correction and wear schedule, ocular diagnoses, ocular medications and drops, surgeries, trauma, amblyopia or patching, and family history of glaucoma, macular degeneration, retinal detachment, or strabismus. General health: diabetes with HbA1c and retinopathy status, hypertension, autoimmune disease, all medications including over-the-counter and herbal, allergies and the specific reaction. Social: smoking, alcohol, occupation, hobbies such as welding or racquet sports, and driving status.
Elicit red flags specifically: sudden or painless vision loss, flashes and floaters, a curtain or shadow, distortion or metamorphopsia, halos, monocular diplopia, pain, redness, discharge, and transient visual loss.
Worked example
A 62-year-old reports "my left eye went dark for a minute yesterday." Ask about duration in seconds to minutes, whether the loss was altitudinal, associated weakness, speech difficulty, or chest pain, and cardiovascular history. Transient monocular loss lasting under 15 minutes in a vascular-risk patient is amaurosis fugax until proven otherwise; that detail changes the urgency of referral, and the examiner expects you to name it.
Traps
Leading questions ("Is the pain sharp?") contaminate the answer. Interrupting loses marks. Missing over-the-counter or herbal medications, family history of glaucoma, or the date of the last dilation are common misses. Not summarizing, and not asking "Is there anything else?", ends the station weakly.