In this part, you should explore in more depth the aetiology of the patient's illness, and outline the biological, psychological and social forces that have contributed towards
- the development of the patient's illness and
- their response to their illness.
When writing the formulation, you should draw on relevant information from earlier parts of your report and consider the patient's presenting problem in the context of their history of chronic illness. You can also integrate evidence and concepts from the wider literature. However, your statements should focus on understanding the patient, not the literature.
You will need to draw on the precipitating, predisposing and perpetuating factors identified earlier in your summary. Some students find it helpful to use the factors as headings in the formulation. Other students are able to write more freely without them.
Predisposing, precipitating and perpetuating factors
Predisposing factors are the factors in the patient's history that make the patient susceptible or inclined toward presenting with, where applicable, an underlying diagnosis, and has "these symptoms" in this current situation.
Precipitating factors are the immediate factors or events that have caused the patient to present with or experience symptoms now. Depending on their backgrounds, life experiences, supports, coping strategies, and current circumstances, we might expect or even predict that two different people would react differently to the same (precipitating) event.
Perpetuating factors are the factors that are causing the patient's symptoms to continue or progressively worsen.
Unlike the summary, the formulation seeks to link the pieces of information as opposed to listing them.
Most students appear to benefit from structuring the factual information in the history and mental state using headings.