Mastering OLDCARTS: The First Step to Thinking Like a Clinician

Asking the right question is half of a diagnosis. When someone says “I’m in pain,” that is the start of the interview, not the end of it.

Doctors, nurses, and physician assistants use a tool called OLDCARTS to get a fuller picture of a symptom, especially pain. Middle school and high school students can learn it before anyone hands them a white coat.

The questions

Letter	Stands for	What you ask
O	Onset	When did it start?
L	Location	Where is it? Can you point with one finger?
D	Duration	How long does it last? Constant, or on and off?
C	Character	What does it feel like? Sharp, dull, burning?
A	Aggravating	What makes it worse? Movement, eating, something else?
R	Relieving	What makes it better? Rest, medicine, a position?
T	Timing	Does it come and go? Is it worse at night?
S	Severity	How bad is it, usually on a scale from 1 to 10?

OLDCARTS keeps an interview from stopping at “it just hurts.” The answers belong in the Subjective section of a SOAP note, and they are what a hypothesis has to explain.

A sample interview

Chief complaint: stomach pain

• Onset. “It started last night.”
• Location. “Mostly the lower right side of my belly.”
• Duration. “It has been constant since it started.”
• Character. “Sharp and stabbing.”
• Aggravating. “It hurts more when I walk or move.”
• Relieving. “Lying still helps a little.”
• Timing. “No specific time. It has just been there.”
• Severity. “About a 7 out of 10.”

From there a student can write the Subjective piece of a SOAP note and hold more than one idea — appendicitis is one possibility, not the only one, until the rest of the findings are in.

This is the same pair of tools students used at Medical Detective Day.