Phase 1: Guided Interview (Symptoms & History)
Read this before asking the first interview question. Phase 1 closes only when the three non-negotiables at the bottom are satisfied.
Ask these questions conversationally, not as a form, and not all at once. Group them naturally based on where the user is in their journey. Skip questions that don't apply. The goal is to gather enough information to build a useful artifact.
Required branching questions — ask early, before going deeper:
These questions determine which body of evidence is relevant and should be surfaced in the first exchange, not discovered later:
- Onset trigger: Did symptoms start after a specific event — a viral illness, injury, medication change, pregnancy, surgery, or other identifiable trigger? Note any trigger that changes the research landscape significantly.
- Co-occurrence: Is anything else going on — even things that seem unrelated or minor? Fatigue, skin changes, joint pain, mood shifts, GI symptoms, sleep disruption, anything new or different? Do not suggest a connection or interpretation; just collect. Many conditions present as a constellation of symptoms that patients have mentally filed as separate problems. The user may have anchored on one as "the main issue" while co-occurring symptoms are diagnostically significant or change which hypotheses are worth investigating.
- Diagnosis status: Has any diagnosis been given or seriously suggested, or is this still unexplained?
- Care context: Is this a first appointment, a follow-up, or an attempt to get a second opinion?
Do not wait for these to emerge organically. If the user's opening description doesn't answer them, ask directly before moving on.
If the user's opening question is about a specific study, article, or claim: Treat the claim as interview data, not as the deliverable. Acknowledge it, note what condition and question it implies, and proceed with the guided interview: "That study is a useful starting point, let me ask you a few questions so I can put it in context for your specific situation." The claim will be evaluated in Phase 3 as part of the evidence quality assessment, but the literature search should establish the broader evidence landscape first. A single study evaluated in isolation is less useful than a single study situated within the full body of evidence.
Current symptoms:
- What symptoms are you experiencing? (Let them describe freely first)
- For each significant symptom: When did it start? How often does it happen? How would you rate severity on a 0-10 scale? What makes it better or worse?
- How do these symptoms affect your daily functioning? (What can't you do, or what's harder?)
Timeline:
- When did you first notice something was off?
- Have symptoms changed over time — gotten better, worse, or shifted?
- Are there any patterns? (Time of day, menstrual cycle, seasons, stress, food, activity)
- Any significant life events, exposures, or changes around the time of onset?
Medical history context:
- What have you already tried? (Treatments, specialists, tests)
- What diagnoses have been suggested or ruled out?
- Is there relevant family history?
- Are there known personal characteristics that might matter?
- Are you taking any medications or supplements?
What they're looking for:
- Do you have a specific condition you're researching or wondering about?
- What prompted you to look into this now?
- What does your medical team currently think?
- Is this a first appointment or a follow-up? Are you seeing a GP/primary care provider or a specialist? (This shapes which questions will be most useful — a first GP visit calls for different priorities than a specialist workup.)
Build the symptom inventory from their answers using structured dimensions:
- Frequency: How often (daily, weekly, episodic, constant)
- Severity: 0-10 scale or mild/moderate/severe with functional anchors
- Duration: How long each episode lasts
- Functional impact: What activities are affected and how
- Temporal patterns: When symptoms occur, any triggers or relieving factors
- Trajectory: Getting better, worse, stable, fluctuating
These dimensions come from validated clinical assessment approaches. They can help the user offer clinicians structured data instead of a narrative they have to decode during a time-pressured appointment. Refer to symptom-inventory-methodology.md for the methodological grounding behind the elicitation sequence, guidance on functional anchors vs. numeric scales, and when to preserve the patient's own language rather than translating it into clinical terminology.
Symptom assessment is non-negotiable on three points — these are required before closing Phase 1:
A symptom timeline. At minimum: when did this start, and has it gotten better, worse, or stayed the same? A clinician cannot evaluate a symptom without a trajectory. If the user says "a while ago" or "it's been bad," ask once for specificity: "Can you give me a rough timeframe — weeks, months, longer?"
One concrete functional impact statement. Encourage the user to record something specific. Instead of, "It affects my life," they should report a concrete impact like "I can't sleep through the night," "I've missed work twice this month," "I stopped going to the gym." This helps make symptoms legible to a clinician in a time-pressured appointment and is often what gets taken seriously. If the user hasn't offered one, ask: "What's the one thing you can't do, or can't do as well, because of this?"
A content validity check. Before closing the interview, ask: "Is there anything about how this affects you that we haven't captured yet?" This is not optional small talk — it is the mechanism by which important symptom information that falls outside standard categories gets surfaced. Patients with understudied, complex, or atypical conditions frequently have the most diagnostically significant information in their answer to this question. If the user answers, add it to the symptom inventory in their own words. Do not rephrase into clinical language if the original wording is more specific or vivid.
For all other dimensions, use judgment: if the user gives a curt or vague answer and the detail seems clinically relevant, ask one follow-up. Do not interrogate. If they decline or don't know, move on.