A mnemonic for taking a social history
Problems elicited during social history are often a huge part of why the patient is seeking help in the first place, and obviously no dry, cynical acronym can do justice to the impact on their lives — but having a basic structure to hang things on is good. I use the mnemonic/initialism “CATASSTROPHE” (or “CATASTROPHE”):
- Cared for by anyone? Any dependants? Are those carers/dependants in good health themselves? If they’re not family you might not have covered it in family history.
- Accomodation adapted to needs? Particularly, does the patient have any stairs they might have trouble getting up and down, and what do they need to use them for?
- Tenants? A bit contrived, but does the patient live with anyone (versus just being visited by them)?
- Activities of daily living? How well does the patient manage getting to/from bed, washing themselves, getting dressed, cooking, other housework and getting to the shops?
- Sleeping OK? Many painful conditions disturb sleep. Is the patient getting enough? Are they taking anything to help? Painkillers? Sleeping tablets? Recreational drugs?
- Sex life? If brought up tactfully and when appropriate, some people might describe sexual impacts they’d never otherwise have volunteered, which can both be important both to them in themselves and important to you as symptoms of or risk factors for other problems you might have missed. (If you don’t like having an extra ‘S’, perhaps think of this as part of “sleeping” in the sense of “sleeping with”; personally, I find that euphemism annoying.)
- Travelled anywhere recently? Probably most relevant for countries with endemic disease such as TB, for sex tourism and for reactive conditions that might be secondary to holiday illnesses.
- Risk factors? The classic ones, I mean: quantified drinking, smoking. Does the patient get their five fresh fruit/veg a day? How many minutes of cardiovascular exercise per day/week? If they’re at risk of sarcopaenia, are they “using it or losing it”?
- sOcial life? Is the problem isolating them from friends or family (support networks)?
- Psychiatric effects? Are their problems exacerbating existing (primary) problems, or causing them to get stressed, depressed, angry (secondary)? Who do they talk to? It’s sad that we don’t often have enough time to fully explore primary/secondary psychiatric problems, but do they at least know where to go for help?
- Hobbies? Can they still do the things they like to, be that running marathons, playing football, gardening, knitting, reading? ADLs, psych and social all might have touched on this already.
- Employment/finances? Are their problems keeping them from working, or causing them anxiety/stress about being fired? Are they aware of/getting the benefits they might be entitled to? How about their carers?
There’s another CATASTROPHE mnemonic used to explain falls.