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It is important to determine whether the patient is a smoker, an ex-smoker or a lifelong non-smoker. If the patienl smokes, the following information is required: form (cigarettes.

TABLE 1.8 The social history: areas of potential relevance


Birth injury or complications Early parental attachments and disruptions Schooling, academic achievements - difficulties Behavioural problems

Home life: emotional, physicai or sexual abuse' experiences of death and Illness interest and attitudes ol parents

Further education/occupation Higher education and further training

Occupation: current and previous exposure to hazard, e.g. chemicals, foreign travel, accidents and compensation claims Unemployment - duration and reason Attitudes to jab or unemployment


Financial circumstances including loss of Income and debts

Relationships/domestic circumstances

Marital status: quality of relationship and any problems spouse's occupation, and attitudes to the patient's illness Sexual identity - any problems

Other occupants ol the house - any problems, e.g. violence, health and bereavement


lype ol home - size, owned or rented problems with the house neighbours Supporting friends or family

Community support: social and health services Involvement pastoral support and church involvement and other voluntary groups Attitudes to help being provided or offered

Leisure activities

Habits Tobacco Alcohol Caffeine Illicit drugs

Dietary restrictions/eating habits

"Note: Inquiring about sexual abuse requires training and experience. and should be conducted, when indicated, by an appropriately trained clinician.

cigars or pipe); quantity (number of cigarettes/cigars or amount of pipe tobacco per day); duration. If the patient is an ex-smoker, the length of time since the practice ceased should be noted. Staining on the fingers or teeth should raise strong suspicion thai the patienl is or until recently was a heavy smoker. In smokers, the possibility of tobacco-related disease should be considered (Fig. 1.8).

Fig. 1.8 Tobacco-related disorders.

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