Use plain words, move system by system, start broad, then use short prompts; record positives and key negatives that change your working diagnosis.
What The Review Of Systems Does For You
The Review of Systems (ROS) helps you catch symptoms that didn’t surface during the history of present illness. Done well, it saves time, tightens your differential, and guides tests. Done poorly, it snowballs into long lists that don’t help decision-making. The goal here is a lean, reliable ROS that fits real visits.
Core Systems, Purpose, And Patient-Friendly Prompts
Use this quick map before you start. Keep the phrasing short and free of jargon. Offer examples so patients know what you mean.
| System | Why You Ask | Example Lead-In |
|---|---|---|
| General | Weight change, fevers, fatigue point to infection, malignancy, endocrine or other systemic issues. | “Any fever, chills, night sweats, or weight change?” |
| Skin | Rashes, color change, bruising, wounds can signal allergy, infection, or bleeding problems. | “New rashes, itching, sores, or easy bruising?” |
| Head & Eyes | Headache patterns, vision change, eye pain warn about neuro or ocular disease. | “Headaches, blurry vision, eye pain, or light sensitivity?” |
| Ears/Nose/Throat | Hearing loss, congestion, sore throat support respiratory and infection clues. | “Hearing trouble, ear pain, stuffy nose, sore throat?” |
| Cardiovascular | Chest pain, dyspnea, palpitations, edema drive cardiac risk and next steps. | “Chest pain or pressure, heart racing, ankle swelling?” |
| Respiratory | Cough, shortness of breath, wheeze, hemoptysis steer imaging and inhaled meds. | “Cough, wheezing, short of breath, or coughing blood?” |
| GI | Nausea, vomiting, pain, bowel change, bleeding suggest infection, ulcer, IBD, or obstruction. | “Heartburn, belly pain, nausea, vomiting, diarrhea, or blood in stool?” |
| GU | Dysuria, frequency, hematuria, discharge point to UTI, stones, STI, or other causes. | “Burning with urination, going often, blood in urine, discharge?” |
| Musculoskeletal | Pain, swelling, stiffness, weakness inform trauma, arthritis, or autoimmune workups. | “New joint pain, swelling, stiffness, or muscle weakness?” |
| Neurologic | Focal deficits, seizures, dizziness, numbness cue imaging or emergent care. | “Fainting, new weakness, numbness, trouble speaking, seizures?” |
| Endocrine | Heat/cold intolerance, thirst, hair/skin change, polyuria suggest thyroid or glucose issues. | “Heat or cold intolerance, unusual thirst, peeing a lot, hair or skin changes?” |
| Heme/Lymph | Bleeding, easy bruising, swollen nodes point to anemia, coagulopathy, or malignancy. | “Easy bruising, bleeding gums, or tender lumps in neck/armpits/groin?” |
| Psych | Mood, sleep, anxiety, safety shape diagnoses and plans across complaints. | “How’s mood and sleep? Feeling down, anxious, or unsafe?” |
| Reproductive | Menses, pregnancies, discharge, pain guide gynecologic and urologic decisions. | “Periods regular? Any pelvic pain, discharge, or concerns about pregnancy?” |
Asking Review Of Systems Questions The Smart Way
Think of ROS as a tight loop: start broad, screen fast, then zoom where signals appear. Keep your pace steady and your tone relaxed. Patients answer better when they hear plain words and concrete examples.
Set The Stage In Seconds
Open with a micro-script: “I’m going to run quickly through body systems to see if anything else is going on. Short yes/no works; if yes, I’ll ask a bit more.” This frames the task, trims side stories, and respects time. Use friendly body language and eye contact. If you use an interpreter, speak to the patient and pause often.
Go Broad, Then Narrow
Ask one high-yield item per system, then chase positives with 1–2 clarifiers. Example: “Any chest pain or pressure?” If yes, follow with “What brings it on?” and “Do you get short of breath or sweaty with it?” Then move on. Don’t stack five questions at once.
Use Plain Words And Examples
Swap jargon for everyday words. People hear “passing out” more clearly than “syncope.” “Coughing up blood” lands better than “hemoptysis.” The CDC plain language checklist gives handy phrasing moves for clear speech and writing.
Short, Tested Prompts You Can Reuse
Here are simple lines you can keep on a card or in your note template. They’re brief, concrete, and easy to translate.
High-Yield General Screen
- “Any fever, chills, or night sweats?”
- “Unplanned weight change?”
- “New severe pain anywhere?”
Cardiopulmonary One-Two
- “Chest pain or pressure? Short of breath?”
- “Cough most days? Any wheeze?”
- “Leg swelling by day’s end?”
Neurologic Safety Net
- “New weakness, numbness, trouble talking, or bad headache?”
- “Any fainting or seizures?”
Mood And Sleep
- “Over the last two weeks, felt down or had little interest in things?”
- “Trouble falling or staying asleep?”
Keep It Patient-Centered And Efficient
ROS shouldn’t feel like a quiz. Use short questions, then listen fully. If answers drift, kindly refocus: “I’ll come back to that after these quick checks.” For long lists of chronic issues, confirm what’s new or worse.
Use Teach-Back For Clarity
Before you close, check understanding with teach-back: “Just so I’m clear, can you tell me the three symptoms we’re watching?” The method improves recall and safety, and it takes under a minute. See AHRQ’s quick guide to teach-back for a simple workflow you can adopt today.
Document What Matters
Write targeted positives and the few “pertinent negatives” that steer decisions. Avoid full templates full of unchecked boxes. Lists that don’t match the story weaken your note and slow chart review.
Tailor Your ROS To The Visit Type
One size doesn’t fit every encounter. Trim or expand based on the setting, acuity, and patient goals.
Acute Care Visits
Keep the ROS tight and tied to the chief concern. Chest pain calls for cardiopulmonary, GI, and neuro screens. An ankle sprain needs neurovascular status and skin checks, not a deep endocrine sweep—unless the history hints at it.
Chronic Disease Follow-Ups
Anchor the ROS around control markers and medication effects. For hypertension, ask about headache, chest symptoms, swelling, and cough if on ACE inhibitors. For diabetes, ask about thirst, urination, vision changes, numbness, and skin sores.
Annual And Preventive Visits
Use a broad pass through systems, then connect findings to screening, vaccines, and lifestyle counseling. When time is tight, hit general, cardiopulmonary, GI, GU, neuro, and mood.
Adapting For Different Populations
Age, language, and access shape how you ask and what you hear. Small adjustments lift accuracy.
Pediatrics
Ask caregivers for pattern and duration. Add feeding, growth, rashes, sleep, and behavior. Include safety checks like hydration, breathing effort, and rashes that spread fast. Offer choices to older children: “Do you want to answer first, then your parent can add details?”
Geriatrics
Screen for falls, memory change, weight loss, bowel habits, pain, mood, and sleep. Ask about dizziness when standing and any new trouble with walking or dressing. Speak slowly, lower your pitch, and face the patient for better hearing.
Reproductive Health
Ask about periods, bleeding between periods, pelvic pain, discharge, and pregnancy goals. For testicular or prostate concerns, ask about pain, swelling, urinary stream change, or blood in semen or urine.
Telehealth
Share your plan for the call at the start. Ask the patient to sit in a quiet spot and, when relevant, have a scale, thermometer, or home readings nearby. Use video to look at rashes or swelling when safe.
Red Flags You Don’t Want To Miss
These symptom clusters call for quick attention or escalation. If any appear, pause the ROS and handle the risk first.
| System | Red Flags | Next Move |
|---|---|---|
| Cardiac | Crushing chest pain with diaphoresis; syncope with exertion; new palpitations with dizziness. | ECG now; assess vitals; consider emergent transfer. |
| Respiratory | Severe dyspnea, stridor, cyanosis, hemoptysis with instability. | Pulse oximetry; airway support; urgent imaging if stable. |
| Neuro | Face droop, arm weakness, speech change; thunderclap headache; new seizure. | Activate stroke pathway; check glucose; expedite imaging. |
| GI | Black or bloody stools with dizziness; persistent vomiting; severe RLQ pain with fever. | Assess hydration; labs; surgical consult when indicated. |
| GU | Testicular pain with swelling; anuria; high fever with flank pain. | Rule out torsion; bladder scan; urine studies and imaging. |
| Psych/Safety | Active self-harm thoughts, violence risk, or domestic danger. | Ensure safety; follow local pathways; involve trained teams. |
Script Library For Common Complaints
Use these quick scripts to keep ROS tight while you gather what you need. Tweak words to fit the person in front of you.
Chest Pain
“Any pressure, tightness, or burning? Does it spread to arm, jaw, or back? Short of breath, sweaty, or sick to your stomach when it comes?”
Shortness Of Breath
“Is it with activity, at rest, or both? Any wheeze, cough with phlegm, or chest tightness? Worse when lying flat or at night?”
Headache
“Worst ever or new pattern? Any fever, neck stiffness, blurry vision, weakness, or confusion?”
Abdominal Pain
“Where did it start and where is it now? Any vomiting, diarrhea, constipation, or blood in stool? Is food or movement a trigger?”
Fever In A Child
“How many days? Any breathing trouble, stiff neck, rash that spreads fast, very sleepy, or fewer wet diapers?”
Note Templates That Stay Honest
Template tools help; autopilot hurts. Keep a short ROS section with the systems you truly asked. Many teams store a two-line canned statement such as “ROS otherwise negative” only when you actually did a broad pass. If you didn’t ask a system, don’t claim a negative. That habit protects you and helps the next clinician.
Time Savers That Don’t Cut Corners
Little moves save minutes across a clinic day. Batch quick yes/no screens, then do clarifiers in pairs. Use keyboard shortcuts for common phrases that you truly use at the keyboard.
Quick Reference: A Three-Step ROS Flow
1) Screen
Run one clear question per system using plain words.
2) Clarify
For each “yes,” ask one timing/severity question and one impact question.
3) Close And Confirm
State what you heard, document the positives and key negatives, and use teach-back to confirm you and the patient share the same plan.