Early treatment windows are defined from symptom onset, and the date most clinics record is the date of referral. The difference is often months and it changes which evidence applies to the patient in front of you.
So ask the question properly. Not 'how long have you had this?' — which invites a rounded guess — but 'what were you doing when you first noticed it, and what month was that?' Anchor it to an event: a festival, an exam, a job change, a wedding. Then write the month and year in the diagnosis line, not in free text.
The reason is concrete. Trials of very early intervention recruit within 12 weeks of onset. A patient who has had swelling for eight weeks and has just been referred is in a different position from one who has had it for a year, and only the recorded date makes that visible to the next clinician.
- Anchor symptom onset to a memorable event, then record the month and year.
- Put the onset date in the structured diagnosis field, not buried in a letter.
- Distinguish onset of symptoms from onset of swelling; they differ in inflammatory arthritis.
- Flag patients inside the first three months for expedited review.
- Re-ask at the second visit; recall improves once the patient has thought about it.
Why it matters
Whether a patient is inside an early-treatment window is decided by a date most notes never record.
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