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Table of Contents
TheΒ SOCRATES acronym is a useful way of exploring a patient’s presenting symptoms. It is commonly used to take a comprehensive pain history, but it can be applied to most other symptoms.
SOCRATES provides a structure during medical history taking and helps you remember the most important questions to ask when exploring the history of presenting complaint.Β
What does the SOCRATES acronym stand for?
The SOCRATES acronym stands for:
- Site
- Onset
- Character
- Radiation
- Associated symptoms
- Timing
- Exacerbating and relieving factors
- Severity
Using SOCRATES in history taking
SOCRATES provides a structured framework for taking a medical history. Each section of SOCRATES is described below, with example questions.
Depending on the patient’s symptoms, not all parts of SOCRATES may be relevant. For example, some symptoms (e.g. breathlessness or fatigue) will not have a specific anatomical location or radiation.Β Β
Site
Ask about theΒ locationΒ of the symptom:
- βWhere is the [symptom]?β
- βCan you point to where you experience the [symptom]?β
Onset
ClarifyΒ howΒ andΒ whenΒ the symptom developed:
- βDid the [symptom] come on suddenly or gradually?β
- βWhen did the [symptom] first start?β
- βHow long have you been experiencing [symptom]?β
Character
Ask about theΒ specificΒ characteristicsΒ of the symptom:
- βHow would you describe the [symptom]?β
- βIs the [symptom] constant or does it come and go?β
Radiation
Ask if the symptomΒ movesΒ anywhereΒ else:
- βDoes the [symptom] spread elsewhere?β
Associated symptoms
Ask if there are other symptoms which areΒ associatedΒ with the primary symptom:
- βAre there any other symptoms that seem associated with the [symptom]?β
Timing
Clarify how the symptom hasΒ changedΒ overΒ time:
- βHow has the [symptom] changed over time?β
Exacerbating and relieving factors
Ask if anything makes the symptomΒ worseΒ orΒ better:
- βDoes anything make the [symptom] worse?β
- βDoes anything make the [symptom]Β better?βΒ
Severity
Assess theΒ severityΒ of the symptom by asking the patient to grade it on a scale of 0-10:
- βOn a scale of 0-10, how severe is the [symptom], if 0 is no [symptom] and 10 is the worst [symptom] youβve ever experienced?β
Examples of SOCRATES questions
These are three examples of using SOCRATES to explore different presenting complaints: chest pain, shortness of breath and a rash. The examples show how SOCRATES can be used for a wide variety of symptoms, not just when taking a pain history.Β
Using SOCRATES to explore chest pain
- Site: βWhere exactly is the pain?β
- Onset: βHow quickly did the pain reach its maximum intensity?β
- Character: βWhat kind of pain are you experiencing?βΒ (e.g. sharp, dull, crushing)
- Radiation: βDoes the pain move anywhere else?β
- Associated symptoms: βHave you developed any other symptoms?βΒ (e.g. shortness of breath, pre-syncope, syncope)
- Timing: βHow long has the chest pain been present?β
- Exacerbating and relieving factors: βDoes anything make the pain worse?β βDoes anything reduce the pain?β
- Severity: βOn a scale of 1-10, how severe would you rate your pain?βΒ (this can be useful later when assessing the impact of treatment)
For more information, see the Geeky Medics OSCE guide to taking a chest pain history.
Using SOCRATES to explore shortness of breath
- Site: n/a
- Onset: βWhen did the shortness of breath first start?β βDid the shortness of breath come on suddenly or gradually?β
- Character: βHow would you describe the shortness of breath?βΒ (e.g. βtight chestβ, βcanβt take a deep breathβ)
- Radiation: n/a
- Associated symptoms: βAre there any other symptoms that seem associated with the shortness of breath?β
- Timing: βHow has the shortness of breath changed over time?β
- Exacerbating and relieving factors: βDoes anything make the shortness of breath worse?β βDoes anything make the shortness of breath better?β
- Severity: βOn a scale of 1-10, how severe would you rate your shortness of breath?β
For more information, see the Geeky Medics OSCE guide to taking a respiratory history.
Using SOCRATES to explore a rash
- Site:Β βWhere is the rash?β
- Onset: βWhen did you first notice the rash?β
- Character: βHow does the rash feel when you touch it?β βWhat is the shape of the rash?β
- Radiation: βHas the rash spread anywhere else?β
- Associated symptoms:Β βAre there any other symptoms that seem associated with the rash?βΒ βHave you noticed the skin lesion itching or bleeding?β
- Timing:Β βHow has the rash changed over time?β
- Exacerbating and relieving factors:Β βDoes anything seem to make the rash worse?β βDoes anything make the rash better?β
- Severity: n/a (could be asked if associated pain with the rash)
For more information, see the Geeky Medics OSCE guide to taking a dermatology history.Β
Alternatives to the SOCRATES acronym
OLD CARTS
OLD CARTS is an alternative mnemonic which can be used to explore the key aspects of each symptom. OLD CARTS stands for:
- Onset
- Location/radiation
- Duration
- Character
- Aggravating factors
- Relieving factors
- Timing
- Severity
For more memory aids, see the Geeky Medics collection of medical mnemonics.Β