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Table of Contents
Theย 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.ย
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.ย ย
Site
Ask about theย locationย of the symptom:
- โWhere is the [symptom]?โ
- โCan you point to where you experience the [symptom]?โ
Onset
Clarifyย howย andย whenย the symptom developed:
- โDid the [symptom] come on suddenly or gradually?โ
- โWhen did the [symptom] first start?โ
- โHow long have you been experiencing [symptom]?โ
Character
Ask about theย specificย characteristicsย of the symptom:
- โHow would you describe the [symptom]?โ
- โIs the [symptom] constant or does it come and go?โ
Radiation
Ask if the symptomย movesย anywhereย else:
- โDoes the [symptom] spread elsewhere?โ
Associated symptoms
Ask if there are other symptoms which areย associatedย with the primary symptom:
- โAre there any other symptoms that seem associated with the [symptom]?โ
Timing
Clarify how the symptom hasย changedย overย time:
- โHow has the [symptom] changed over time?โ
Exacerbating and relieving factors
Ask if anything makes the symptomย worseย orย better:
- โDoes anything make the [symptom] worse?โ
- โDoes anything make the [symptom]ย better?โย
Severity
Assess theย severityย of the symptom by asking the patient to grade it on a scale of 0-10:
- โOn a scale of 0-10, how severe is the [symptom], if 0 is no [symptom] and 10 is the worst [symptom] youโve ever experienced?โ
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.ย
Using SOCRATES to explore chest pain
- Site: โWhere exactly is the pain?โ
- Onset: โHow quickly did the pain reach its maximum intensity?โ
- Character: โWhat kind of pain are you experiencing?โย (e.g. sharp, dull, crushing)
- Radiation: โDoes the pain move anywhere else?โ
- Associated symptoms: โHave you developed any other symptoms?โย (e.g. shortness of breath, pre-syncope, syncope)
- Timing: โHow long has the chest pain been present?โ
- Exacerbating and relieving factors: โDoes anything make the pain worse?โ โDoes anything reduce the pain?โ
- Severity: โOn a scale of 1-10, how severe would you rate your pain?โย (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: โWhen did the shortness of breath first start?โ โDid the shortness of breath come on suddenly or gradually?โ
- Character: โHow would you describe the shortness of breath?โย (e.g. โtight chestโ, โcanโt take a deep breathโ)
- Radiation: n/a
- Associated symptoms: โAre there any other symptoms that seem associated with the shortness of breath?โ
- Timing: โHow has the shortness of breath changed over time?โ
- Exacerbating and relieving factors: โDoes anything make the shortness of breath worse?โ โDoes anything make the shortness of breath better?โ
- Severity: โOn a scale of 1-10, how severe would you rate your shortness of breath?โ
For more information, see the Geeky Medics OSCE guide to taking a respiratory history.
Using SOCRATES to explore a rash
- Site:ย โWhere is the rash?โ
- Onset: โWhen did you first notice the rash?โ
- Character: โHow does the rash feel when you touch it?โ โWhat is the shape of the rash?โ
- Radiation: โHas the rash spread anywhere else?โ
- Associated symptoms:ย โAre there any other symptoms that seem associated with the rash?โย โHave you noticed the skin lesion itching or bleeding?โ
- Timing:ย โHow has the rash changed over time?โ
- Exacerbating and relieving factors:ย โDoes anything seem to make the rash worse?โ โDoes anything make the rash better?โ
- 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.ย
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.ย