Unlike the general practitioner, hospital doctors usually have little or no awareness of the patient's personal and social background, This information can prove useful in identifying the patient's problem and how best to manage the situation. For instance the management of a patient who has to care for a disabled spouse may differ front that of a patient with the same disease and a healthy supportive partner.
The same principles of nests and layers in the selection of the appropriate questions to ask apply. For example, if an elderly patient presents with dementia or a fractured hip, the sexual orientation will be irrelevant and illicit drug misuse (although not alcohol abuse) so unlikely that any inquiries may cause upset and antagonism. However, inquiries about with whom the patienl lives, whether there is additional help at home, and whether the house is on Lhe ground floor or at the top of a tenement building may be crucial.
A social history should not only include basic information about current domestic arrangements and occupation, and the usage of alcohol and tobacco, but also whether any major previous, recent or imminent life changes have occurred.
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