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A.K.A. "OLDCART"
OLDCART
is a mneumonic that may help you learn and remember the seven dimensions.
“O” = Onset
“L” = Location
“D” = Duration
“C” = Characteristics
“A” = Aggravating and/or relieving
factors
“R” = Related symptoms
“T” = Treatments tried (and the patient’s
response)
Select
each dimension on the left to learn more about it.
One important convention in medical patient charting (that is, charting
done by an examining provider) is the organization of the patient
history around the Seven Dimensions of a Symptom. The seven dimensions
are intended to assist you in building a word picture of the problem,
or chief complaint (CC). Your ability to “speak the language”
(or write it) is an important skill – and the consistent organization
that using these seven dimensions provides is invaluable. They are
discussed individually below, but in reality, one amplifies another.
You may find yourself returning to a previous dimension to clarify
the current dimension being discussed.
With experience,
you may add other items that seem equally important. For
example, when the CC is not self evident (i.e., an injury or accident),
it may be
helpful
to ask the patient what they think has happened, is happening, is
wrong... whichever phrase is applicable. There are several benefits
to asking this question. People often have a sixth sense about what
might be wrong, or going on with, their body. People under stress
are often poor historians. More often than one might
expect, they have secret fears about what may be wrong. Of course,
if a patient
shares a secret fear with you, you should never laugh or dismiss
their concerns;
you have an obligation to take their concerns seriously and do whatever
you can to prove that their fear is unfounded – or not.
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