"Hello, I’m [Your Name], one of the doctors/nurses. I understand you've come in today because you've experienced a loss of consciousness. Is that right?"
"Before we go any further, what are your thoughts about what might have caused you to lose consciousness, 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 what happened? What were you doing just before you lost consciousness? Did anything trigger it, like standing up quickly, feeling pain, being stressed, or during exertion? What about coughing, urinating, or having a bowel movement?"
"Did you have any warning signs before you blacked out? Like feeling dizzy, lightheaded, nauseous, visual changes, sweating, or your heart racing (palpitations)? Some people experience a strange sensation or 'aura' before losing consciousness."
"What happened during the episode itself? Were you limp (flaccid), or did your body become stiff? Did you have any jerking movements or spasms? Were there any generalized tonic-clonic movements, or did your back arch?"
"How long do you think you were unconscious for? If someone was with you, it would be very helpful to get their account of the episode, including how long it lasted and what they observed."
"Did you bite your tongue during the episode? If so, was it on the side of your tongue? Did you lose control of your bladder or bowels? Did your skin turn blue (cyanosis) or very pale (pallor)?"
"How long did it take you to recover completely after the episode? Were you confused or drowsy? Did you have any weakness on one side of your body, or a headache?"
"Have you had any previous episodes of losing consciousness? If so, how many, and how often do they occur? What were the circumstances of those episodes, and were they similar to this one?"
"Did you sustain any injuries during the episode, such as a head injury, fractures, or cuts?"
"Do you have any existing medical conditions? I'm particularly interested in conditions that might be associated with losing consciousness, such as low blood pressure when standing up (postural hypotension), heart rhythm problems like a slow or fast heartbeat (arrhythmias), any structural heart disease like problems with your heart valves or muscle (cardiomyopathy)? What about epilepsy, diabetes, a history of stroke or mini-stroke (TIA), or severe migraines? Have you ever been diagnosed with anxiety or panic attacks?"
"Have you ever had any operations or procedures, especially any heart or brain surgery?"
"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 those for high blood pressure (antihypertensives), water tablets (diuretics), heart rhythm medications (antiarrhythmics), epilepsy medications (antiepileptics), antidepressants, sedatives, or medications for diabetes (insulin/oral hypoglycaemics) can sometimes be related to loss of consciousness."
"Have there been any recent changes to your medications – perhaps a new one started, one stopped, or a dose changed?"
"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 – like your parents, siblings, or children – have a history of sudden cardiac death, epilepsy, or any other inherited heart conditions like Long QT syndrome or Brugada syndrome? What about other neurological 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?"
"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, especially stimulants like cocaine or amphetamines, or depressants? What about volatile substances?"
"What's your typical fluid intake like? How about your diet and exercise habits?"
"What kind of work do you do, and are there any high-risk activities involved, like operating machinery or driving?"
"Regarding driving, it's very important that we discuss the implications of this episode. You will need to inform the DVLA/relevant licensing authority about any episode of loss of consciousness. It's usually advised not to drive until we have a clear diagnosis and understand the cause."
"Thank you very much for sharing all of that information with me. Just to summarise, you experienced [recap key details of LOC episode], with [recap prodromal symptoms, movements, duration, key features]. This has impacted you by [recap injuries, concerns]. 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 neurological systems, and checking your vital signs. We might also arrange for some investigations, such as an ECG (heart tracing), blood tests (like a full blood count, kidney and liver function tests, glucose, and cardiac enzymes), or imaging like a CT scan or MRI of your brain. Depending on the suspected cause, we might also consider an EEG (brain wave test), a tilt table test, or continuous heart monitoring (Holter monitoring). We may also refer you to a heart specialist (cardiologist) or a brain specialist (neurologist)."
"Do you have any questions for me at this stage?"
"Thank you for your time."