Clinical Assessment Framework

Comprehensive Algorithm & Matrix · BS Derma Clinic

OPQRST Framework

O

Onset

When did symptoms start?

Sudden vs gradual; exact time/date of first occurrence.

P

Provocation / Palliation

What makes it better or worse?

Movement, rest, position, food, medications, stress.

Q

Quality

Describe the symptom.

Sharp, dull, burning, cramping, throbbing, stabbing.

R

Radiation / Region

Where is it? Does it spread?

Exact location and any radiation pattern.

S

Severity

Scale 1–10.

Patient-rated intensity; 0 = none, 10 = worst imaginable.

T

Timing

Pattern, duration, frequency.

Constant vs intermittent; how often; how long each episode.

SOCRATES Framework

S

Site

Exact location.

Point to where it hurts most.

O

Onset

Sudden vs gradual.

Speed of onset; what was the patient doing?

C

Character

Sharp, dull, burning, etc.

Quality of the sensation.

R

Radiation

Where does it spread?

Any referred pain pattern.

A

Associations

Related symptoms.

Nausea, fever, numbness, etc.

T

Time course

Duration and pattern.

Getting better/worse/stable.

E

Exacerbating / Relieving

What makes it better/worse?

Factors that change the symptom.

S

Severity

Intensity scale.

0–10 numeric rating.

Specialty-Tailored OPQRST (BS Derma Multi-Specialty)

SpecialtyOnsetProvocationQualityRadiationSeverityTiming
General MedicineGradual vs suddenActivities, stressSharp, dull, crampingWhere it spreads1–10 scalePattern, frequency
PediatricsAge-appropriate timelineSchool, play, feedingCrying pattern, behaviorWhole body assessmentFLACC / Wong-BakerSleep, eating patterns
DermatologyFirst noticed whenSun, products, clothingItchy, burning, painfulDistribution patternDLQI / SkindexSeasonal, episodic
Laser / AestheticPre / post procedureTreatment expectationsSatisfaction level desiredTreatment area extentAesthetic concern scaleRecovery timeline

Patient Encounter Flowchart

1
Patient Presentation
↓
2
Chief Complaint Assessment (OPQRST / SOCRATES)
↓
3
Review of Systems (ROS)
↓
4
Physical Examination
↓
5
Risk Stratification → Low / Moderate / High
↓
6
Diagnosis Formulation (Primary / Secondary / Differential)
↓
7
Treatment Implementation (Medications / Procedures / Infusions / Monitoring)
↓
8
Disposition Planning (Discharge / Transfer / Admission)
↓
9
Follow-up Coordination (Appointments / Results / Care Plan / Education)