"Hello, I’m [Your Name], one of the doctors/nurses. I understand you've come in today because you've been experiencing swelling in your legs. Is that right?"
"Before we go any further, what are your thoughts about what might be causing this leg swelling, or what it might mean?"
"And is there anything in particular that you're worried about, or anything you were hoping we could achieve during our conversation today?"
"Could you please tell me more about the leg swelling? Is it in one leg or both? If it's just one, which leg is it?"
"When did the swelling first start, and did it come on suddenly or gradually? How long has it been present?"
"How would you describe the swelling? If you press on it, does it leave a dent or 'pit' (pitting oedema)? Has the skin changed color – is it red, bluish, or brownish? Does it feel warm or cool to touch?"
"How has the swelling changed over time? Is it getting worse, staying the same, or does it fluctuate?"
"Have you noticed any other symptoms happening with the swelling? Like pain, redness, or itching in the leg? What about a fever or rash? Are you feeling short of breath, or having any chest pain or palpitations? Any cough? Have you gained weight recently, or noticed swelling in your abdomen? For women, have you had any unusual vaginal bleeding or discharge?"
"Can you describe any pain in the affected leg(s)? Where is it, how severe is it, what does it feel like (e.g., aching, sharp), and does it spread anywhere? What makes it better or worse?"
"Does the swelling change throughout the day? For example, is it worse by the end of the day or after standing for a long time? Does it improve if you rest or elevate your legs?"
"How does this leg swelling impact your daily life? Does it affect your mobility, or your ability to wear certain shoes or clothing? Does it make hygiene more difficult?"
"I also need to ask about some important 'red flag' symptoms. Did the swelling in one leg come on very suddenly and is it associated with pain, warmth, or redness, which could suggest a blood clot (DVT)? Are you experiencing any chest pain or severe shortness of breath along with the swelling, which could indicate a clot in your lungs (PE)? Do you have a fever and severe pain in the leg, suggesting an infection like cellulitis? Or if the swelling is in both legs and worsening rapidly with significant breathing difficulties, this could be a sign of heart failure."
"Do you have any existing medical conditions, such as heart failure, kidney disease, liver disease like cirrhosis, a history of deep vein thrombosis (DVT) or pulmonary embolism (PE)? What about varicose veins or chronic venous insufficiency, problems with your lymphatic system (lymphoedema), or thyroid disease? Have you ever had any growths or masses in your pelvis?"
"Have you ever had any operations or procedures, especially any abdominal or pelvic surgery, orthopaedic surgery, or surgery where lymph nodes were removed?"
"Are you currently taking any medications, including anything prescribed by a doctor, or any over-the-counter medicines, supplements, or herbal remedies? Some medications, like certain blood pressure tablets (e.g., amlodipine), anti-inflammatory drugs (NSAIDs), steroids, oral contraceptives, or hormone replacement therapy, can sometimes cause leg swelling."
"Have there been any recent changes to your medications?"
"Do you have any allergies to medications or anything else? If so, what kind of reaction did you have?"
"Does anyone in your close family have a history of clotting disorders like DVT or PE, heart problems, kidney disease, liver disease, or lymphatic conditions?"
"Could you tell me a little about your living situation and who you live with? Do you have a good support network around you? Are you able to manage all your daily activities independently?"
"Have you had any recent prolonged periods of immobility, such as long flights or bed rest after an illness or injury? Have you experienced any recent trauma to your legs?"
"How about your lifestyle? Do you smoke, and if so, how much? How much alcohol do you drink in a week? Do you use any recreational drugs?"
"What's your typical diet like, especially your salt intake? How about your fluid intake and exercise habits?"
"What kind of work do you do? Does your job involve prolonged standing or sitting?"
"Thank you very much for sharing all of that information with me. Just to summarise, you've been experiencing [recap key symptoms], which started [onset] and are often [character/timing]. This has been impacting your [daily life areas]. You've also mentioned [recap relevant PMH/DH/FH/SH]."
"Does that sound like an accurate summary? Is there anything else you feel is important that we haven't covered?"
"Based on what you've told me, the next steps would be for me to perform a physical examination, focusing on your cardiovascular and respiratory systems, and a thorough examination of your legs. We'll also check your vital signs and may arrange for some investigations, such as a urine dipstick, blood tests (like U&Es, LFTs, thyroid function tests, or a D-dimer if we suspect a clot), and possibly imaging like a Doppler ultrasound of your legs, a chest X-ray, or an ECG."
"Do you have any questions for me at this stage?"
"Thank you for your time."