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CMS100 > W 11, 12 > Flashcards

W 11, 12 Flashcards

1
Q

What is the purpose of medical interviewing?

A
  • to gather information
  • to establish a safe atmosphere and trusting relationship with the patient
  • to provide patient education (inform and motivate the patient)
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2
Q

What is a biomedical approach?

A
  • focuses on biological factors
  • defines health as “absence of disease”
    (reductionist; singular concepts)
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3
Q

What is biopsychosocial approach?

A
  • connects biological factors with psychological and social
  • allows for increased understanding of illness and health
    (considers multiple factors at once)
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4
Q

What is the hierarchy of natural systems?

A

Bio (bodily systems) -> Psycho (experience and behavior) -> Social (Culture, community, family)

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5
Q

What are the determinants of health?

A
  1. Biology (genetics, sex, age)
  2. Social (education, occupation, culture, norms, attitudes)
  3. Behavior (diet, exercise, substance use)
  4. Medical system (health policy, access to care)
  5. Environment (living conditions worksites, schools, exposure to toxins)
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6
Q

Why should medical interviewing be improved?

A
  • patients seek care due to their experience, not their symptoms
  • patients often have more than one concern
  • being able to tell one’s story is diagnostically useful and therapeutic
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7
Q

What is clinician-centered interviewing?

A
  • close-ended Qs
  • clinician in-charge of the interaction
  • clinician-driven priorities and beliefs (bias)
  • interview to elicit symptoms of disease
  • differentiates potential conditions the patient may be suffering from
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8
Q

What is patient-centered interviewing?

A
  • open-ended Qs
  • patient leads the interaction
  • allows patient to express importance / expectations
  • interview to elicit experience of disease (symptoms and personal concerns, feelings and emotions)
  • builds and maintains clinician-patient relationship
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9
Q

Open-ended data gathering skills include:

A
  1. non-focusing
    - silence
    - non-verbal encouragement (eye contact, hand gestures, leaning forward)
    - continuers
  2. focusing
    - echoing (repeating)
    - requesting
    - summarizing
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10
Q

Close-ended data gathering skills include:

A
  • Yes/No answers
  • brief replies
  • MCQ
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11
Q

Emotion-seeking interviewing skills include:

A
  1. direct inquiry
  2. indirect inquiry
    - inquiring about impact
    - eliciting beliefs or attributions
    - intuiting how the patient might be feeling
    - asking about triggers
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12
Q

Conveying-empathy interviewing skills include:

A

NURSE
- Name the feeling/ emotion
- repeat the feeling expressed by the patient
- state the feeling u observed
- Understand statement
- Respect
- Support
- Exploring emotions

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13
Q

What are the components of “beginning of interview” stage?
SUBJECTIVE

A
  • Preparation (1-3 mins)
    1. set the stage (30-60s)
    2. set the agenda (cc, concern list; 1-2 mins)
  • Patient-centered HPI (4-12 mins)
    3, 4, 5. early interview (symptom(s) description, personal and emotional context; using PATIENT-CENTRED skills)
  • Transition (30s)
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14
Q
  1. Setting the stage (30-60 s):
A
  1. prepare for patient consult (read intake form/chart, familiarize yourself with patient’s problem list, medications, allergies, relevant past medical history)
  2. welcome/ greet the patient
  3. use patient’s name
  4. introduce urself and identify specific role
  5. ensure patient readiness and privacy
  6. address barriers to communication (sit down)
  7. ensure comfort and put patient at ease
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15
Q
  1. Set the agenda (elicit cc; 1-2 mins):
A
  1. indicate time available
  2. forecast what you would like to do during the interview
  3. obtain a list of all issues the patient wants to discuss (specific symptoms, requests, expectations, understanding)
  4. summarize and finalize the agenda (negotiate specifics if too many agenda items)
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16
Q
  1. opening the history of present illness (30-60 s):
A
  1. open-ended Qs/statements
  2. use non-focusing open-ended skills (attentive listening)
  3. obtain additional data from non-verbal sources: physical characteristics, autonomic changes, accoutrements, environment and self
17
Q

Non-verbal information includes?

A
  • physical characteristics: general health, skin and hair color, odor, deformities, habitus (emaciated, disheveled, “uremic” breath, jaundice, amputated, kyphoscoliosis)
  • autonomic changes: heart rate, skin color, pupil size, skin moisture, skin temperature
  • accoutrements or accessories: clothing, jewelry, eyeglasses…
  • environment: hospital (greeting cards, flowers, photographs)
  • self: aware of your own emotions and reactions to patients
18
Q
  1. learn patient experience of illness (3-10 mins):
A
  1. obtain further description of the symptoms= SYMPTOM STORY
  2. elicit/ develop understanding of PERSONAL CONTEXT (psychological and social)
  3. elicit/develop understanding of EMOTIONAL IMPACT
  4. respond to feelings and emotions with empathy skills (NURSE)
  5. expand the story to new chapters
19
Q
  1. Transition to middle of interview (30-60 s)
A
  1. brief summary
  2. check accuracy
  3. indicate that both content and style of inquiry will change if the patient is ready
20
Q

What are the components of “middle of interview” stage?
SUBJECTIVE

A

6, 7, 8, 9, 10. predominantly symptom data collection

CLINICIAN-CENTRED skills

21
Q
  1. History of present illness (HPI) includes:
A

complete a chronological description of the patient’s chief concern and other active problems
1. obtaining and describing data without interpreting it
(recall OLD CARTS)
2. interpreting data while obtaining it (symptom ppt vs illness scripts)
3. Understand the patient’s perspective: impact (meaning) of illness on self/others, health beliefs, triggers for seeking care

22
Q

OLD CARTS?

A
  • Onset
  • Location/radiation
  • Duration
  • Character
  • Aggravating factors
  • Relieving factors
  • Timing
  • Severity
23
Q

by the end of step 6, u should have a working diagnosis with a clear clinical impression what is going on in the patient’s case.
True or False

A

True

24
Q

Non-symptom info (imaging, blood work) obtained from the patient is considered secondary info and requires verification.
True or False

A

True

25
Q
  1. Past Medical History (PMH) includes:
A
  • screen for major diseases/ diagnosis
  • previous injuries or medical interventions
  • hospitalizations
  • immunizations
  • preventative/ public health screening
  • women’s health history (menarche, menstrual cycle, contraceptive use, obstetric history)
  • medications and other treatments
  • allergies and drug rxn’s
26
Q
  1. Social or Psychosocial History (SH) includes:
A
  • occupation
  • health promotion (diet, physical activity)
  • safety (seat belt use, smoke detectors in home)
  • health screening
  • exposures (pets, travel, illness at home/work)
  • substance use
  • personal (living arrangement, relationships/support systems, sexual, orientation/practices, stress, mood, spirituality)
  • health literacy
  • hobbies/ recreation
  • important life experiences (military service, family relationships)
  • legal issues
27
Q
  1. Family history (FH) includes:
A

information on contagious, toxic, familial and heritable diseases

28
Q
  1. Review of systems (ROS) includes:
    OBJECTIVE
A
  • ask about RELEVANT symptoms or any secondary data not yet addressed
  • ROS is used as a final screening tool to understand the degree of impact the illness has placed on the patient’s life
  • complete physical exam and discuss results of availability laboratory findings
    (could be added in ur intake form)
29
Q
  1. End of interview includes:
A
  1. share info
  2. assess understanding, provide written plan/instructions
  3. invite patient to participate in shared decision making
  4. close the visit (clarify next steps- what u’ll do, what the patient will do and time of next communication)
  • patient education, set goals and obtain commitment establish plan

CMS100 (12 decks)

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