The Review of Systems (ROS) is a structured inventory of symptoms a patient may be experiencing, systematically checking the body’s various organ systems. It is obtained through a series of questions posed to the patient, either verbally by a healthcare provider or via a patient intake form or questionnaire. The goal is to identify any signs or symptoms the patient is currently experiencing or has experienced recently, as part of a comprehensive medical history. This process focuses entirely on the patient’s subjective report, serving as a critical step before the objective physical examination.
The Role of the Review of Systems in Patient Care
The primary function of the Review of Systems is to serve as a broad screening tool that ensures a comprehensive assessment of the patient’s overall health. It is designed to uncover symptoms that may be unrelated to the patient’s chief complaint but are still medically significant, such as a concurrent illness or an undiagnosed comorbidity. The structured questioning of the ROS helps bring these minor symptoms to light.
The information gathered assists in formulating a differential diagnosis, which is the list of possible conditions causing the patient’s symptoms. By systematically ruling in or ruling out symptoms across different body systems, the provider strengthens diagnostic accuracy. Furthermore, a thorough ROS creates a standardized narrative for the medical record, demonstrating attention to detail and providing a safeguard for quality assurance and documentation compliance.
Categorizing the Body Systems
The Review of Systems systematically checks for symptoms across all major organ systems. The Centers for Medicare and Medicaid Services (CMS) recognizes a standard list of 14 categories:
- Constitutional symptoms: Checks for general systemic indicators like fever, chills, night sweats, fatigue, or unexplained weight change.
- Eyes: Reviewed for changes in vision, eye pain, redness, or double vision.
- Ears, Nose, Mouth, and Throat (ENT): Includes questions about hearing loss, ringing in the ears (tinnitus), sore throat, or nasal congestion.
- Cardiovascular: Focuses on chest pain, palpitations, shortness of breath, or leg swelling (edema).
- Respiratory: Reviewed for symptoms such as cough, wheezing, coughing up blood (hemoptysis), or difficulty breathing.
- Gastrointestinal: Targets nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in stool.
- Genitourinary: Includes symptoms like pain or difficulty with urination, blood in the urine, or unusual discharge.
- Musculoskeletal: Addresses joint pain, stiffness, swelling, muscle weakness, or back pain.
- Integumentary (Skin and Breast): Involves questions about rashes, itching, lumps, or lesions.
- Neurological: Symptoms include headaches, dizziness, fainting (syncope), numbness, tingling, or seizures.
- Psychiatric: Screens for anxiety, depression, mood changes, or sleep disturbances.
- Endocrine: Reviewed for intolerance to heat or cold, excessive thirst or urination, or unexplained weight changes.
- Hematologic/Lymphatic: Covers easy bruising, prolonged bleeding, or swollen lymph nodes.
- Allergic/Immunologic: Addresses known allergies, frequent infections, or autoimmune symptoms.
Techniques for Eliciting Information
The process of performing the Review of Systems involves a structured technique designed to efficiently gather comprehensive subjective data. The scope of questioning determines whether a comprehensive or a focused ROS is conducted, depending on the clinical context. A comprehensive ROS reviews at least ten of the fourteen body systems and is typically performed during a patient’s initial visit or for a general health assessment.
A focused ROS limits the inquiry to the system directly related to the chief complaint and a limited number of additional systems, generally used for follow-up visits or specific urgent care issues. Questions are structured as closed-ended queries, such as “Have you had any chest pain?” to which the patient answers “yes” or “no.” If a positive symptom is identified, the provider then uses open-ended questions to gather more detail, transforming that finding into part of the history of the present illness.
How the ROS Differs from the History of Present Illness
The History of Present Illness (HPI) and the Review of Systems are distinct but sequential components of the medical history. The HPI is a detailed, chronological narrative focused exclusively on the patient’s chief complaint, describing the characteristics of the primary problem. It thoroughly explores the location, quality, severity, duration, timing, context, and associated signs and symptoms related to the main issue.
The ROS, however, is a systematic inventory that screens for symptoms across all body systems, regardless of their connection to the chief complaint. While the HPI provides a deep dive into one specific issue, the ROS offers a broad, system-by-system sweep to uncover other health concerns. For documentation purposes, information used to detail the HPI should not be counted again as part of the ROS, ensuring a clear medical record.