The Review of Systems (ROS) is a structured interview used by healthcare providers to gather comprehensive subjective information from a patient. It functions as a systematic inventory of symptoms across all major organ systems, serving as a formalized checklist for the patient’s current and past health status. The ROS is a fundamental part of the complete patient history, complementing the chief complaint and the history of the present illness. It is entirely based on the patient’s self-reported experiences and is distinct from the physical examination, which involves the provider’s objective findings. This structured approach ensures no relevant symptoms are overlooked, helping identify conditions that may present with non-specific or seemingly unrelated complaints.
Purpose and Scope of the Review of Systems
The primary purpose of the Review of Systems is to uncover symptoms the patient may not have initially mentioned because they seemed unrelated to the main reason for the visit. Patients often focus only on their most bothersome symptom, not realizing that a minor symptom could signal an underlying systemic issue. The ROS acts as a diagnostic net, systematically broadening the inquiry beyond the immediate problem.
This comprehensive screening is valuable for identifying occult or chronic conditions that might otherwise be missed during a problem-focused history. For instance, a patient with an ankle sprain might report excessive thirst and frequent urination, symptoms pointing toward an undiagnosed condition like diabetes. The broad scope of the ROS ensures a holistic understanding of the patient’s health status, regardless of their presenting illness.
Systematic Approach to Questioning
A comprehensive ROS is structured around a standardized list of body systems to ensure completeness and consistency in data collection. The Centers for Medicare and Medicaid Services (CMS) recognizes 14 distinct systems that form the basis of a thorough review:
- Constitutional Symptoms
- Eyes
- Ears/Nose/Mouth/Throat (ENT)
- Cardiovascular
- Respiratory
- Gastrointestinal
- Genitourinary
- Musculoskeletal
- Neurological
- Psychiatric
- Endocrine
- Hematologic/Lymphatic
- Allergic/Immunologic
- Skin/Integumentary
Constitutional System
This system is typically addressed first, focusing on general indicators of health like fever, unintentional weight loss or gain, fatigue, and changes in sleeping patterns. A positive response, such as unexplained weight loss, often suggests a systemic illness that warrants immediate and deeper investigation.
Cardiovascular System
For the Cardiovascular system, questions zero in on symptoms related to heart and blood vessel function. The clinician will inquire about chest pain, palpitations, shortness of breath, claudication (leg pain with walking), and swelling in the extremities (edema). These questions are designed to screen for issues ranging from coronary artery disease to congestive heart failure.
Musculoskeletal Review
In the Musculoskeletal review, the inquiry covers the bones, joints, and muscles. Specific questions involve joint pain or stiffness, muscle aches or weakness, and any history of back pain or arthritis. This section helps identify inflammatory conditions, degenerative disorders, or systemic problems like autoimmune diseases that affect the joints.
Neurological System
The Neurological system assessment screens for issues related to the brain, spinal cord, and peripheral nerves. The interviewer will ask about headaches, dizziness, numbness or tingling in the extremities, seizures, or unexplained muscle weakness. A positive finding in this system can signal a wide array of conditions, from migraines to stroke-related deficits.
Techniques for Eliciting Information
Effective interview methodology and strong communication skills are necessary to conduct the ROS and put the patient at ease. The process begins with broad, open-ended questions to encourage the patient to speak freely about any other concerns. Phrases like, “Other than what we’ve discussed, have you noticed any other changes with your health recently?” facilitate a natural flow of information.
Once the patient has offered their initial account, the interviewer transitions to more specific, closed-ended probing questions for each body system. This structured approach, moving from general to specific, ensures that no detail is overlooked and converts the patient’s narrative into a structured inventory of symptoms. Clinicians must avoid complex medical jargon and use simple, everyday language so the patient fully understands the questions.
For sensitive systems, such as Psychiatric or Genitourinary categories, professionalism and a non-judgmental approach are paramount. Questions about anxiety, depression, or sexual health should be introduced with clear, respectful language in a private setting to maximize patient comfort and honest reporting. If a patient gives an ambiguous answer, the clinician must clarify the response immediately, establishing the symptom’s onset, duration, and severity.
Documentation and Reporting
The findings from the Review of Systems must be recorded in the patient’s medical record using standardized terminology, categorized by body system. This documentation is necessary for continuity of care, allowing other providers to quickly grasp the patient’s full symptom profile.
A documented ROS must differentiate between positive findings (symptoms reported) and pertinent negative findings (relevant symptoms denied). For example, a patient with chest pain should have a recorded pertinent negative for shortness of breath, as the absence of these symptoms helps narrow diagnostic possibilities.
For a comprehensive ROS, which typically involves reviewing ten or more systems, documentation standards permit a streamlined reporting method. The clinician must individually document all systems with positive findings and any pertinent negatives. For the remaining systems where the patient denies all symptoms, a general notation such as “All other systems negative” is acceptable. This helps maintain a concise record while confirming the breadth of the inquiry. The level of detail and the number of systems reviewed influences the complexity of the medical documentation and is a factor in billing and coding for the encounter.