Chief Complaint

Question 1

The interview: general principles

Answer 1

1. consider all factors - bio, psych, social
2. Listening skills and empathy
3. The doctor/patient relationship - developing rapport, patient satisfaction

Question 2

Setting the stage

Answer 2

1. Review the chart
2. The environment
3. Respect

Question 3

Review the chart

Answer 3

1. past diagnoses, treatment, medications
2. referral info
3. identifying info

Question 4

The environment

Answer 4

1. quiet, comfortable

2. professional

Question 5

respect

Answer 5

punctuality, terms of address, knock on door, personal appearance, distance/personal space/nonverbals, no barrier, same height, unconditional positive regard, listen, then write

Question 6

opening the interview

Answer 6

introduce yourself, define your role, address patients comfort

Question 7

the interview

Answer 7

begin with open ended question, proceed to specific questions, new complaints require resumption of open ended questions, use language terms the patient can understand, ask only 1 question at a time, avoid leading questions, be careful of why questions and tone of voice, provide transitions, accept silence as a reasonable productive part of interview process, define patients entire agenda

Question 8

techniques

Answer 8

facilitation, reflection, clarification, empathic response, confrontation, interpretation, ask about feelings, honestly

Question 9

facilitation

Answer 9

encourage the patient to say more

Question 10

reflection

Answer 10

encourage the patient to give more details

Question 11

empathic response

Answer 11

I understand

Question 12

confrontation

Answer 12

points out to patient something about own words

Question 13

interpretation

Answer 13

takes confrontation a step further

Question 14

obtaining a chief complaint: history of present illness

Answer 14

attributes of a symptom

Question 15

COPMAPS

Answer 15

C-Complaint (quality, location, severity/quantity)
O- Onset (when and how)
P - Progression
M - Mitigating factors (what makes it better, what makes it worse)
A - Associated symptoms
P - Previous Occurrence, pertinent other
S - Summarize

Question 16

Giving info - end of the interview

Answer 16

Closure - is there anything else you would like to discuss, check with the patient for understanding, review with the patient

Question 17

Understanding the patients perspective

Answer 17

express care and concern, acknowledge patients accomplishments

Question 18

end of encounter

Answer 18

create comfortable closure, review the next step

Question 19

Challenges to eliciting the chief complaint

Answer 19

1. The reticent patient
2. the rambler
3. the vague patient
4. the drunken patient
5. the anxious patient
6. the angry patient
7. the cognitively impaired patient
8. the patient who cannot read
9. the hearing impaired patient
10. the vision impaired patient
11. language barriers

Question 20

the reticent patient

Answer 20

may be a sign of depression, dementia, anxiety, cultural differences, interview insensitivity

continue with open ended questions

attentive silence - encourage to go on

Question 21

the rambler

Answer 21

allow free reign for 5-10 minutes; focus on 1 or 2 of most important issues; advise follow up visits to address secondary complaints; avoid displaying anger or frustration; try to direct patient back to one topic at a time; acknowledge your confusion; may indicate anxiety, loneliness, thought disorder, personality style, psychiatric illness

Question 22

the vague patient

Answer 22

is the symptom vague or is the patients description vague; provide a choice of useful descriptors without leading patient

Question 23

the anxious patient

Answer 23

• be sensitive
• encourage the patient to talk about their feelings
• avoid premature reassurance

Question 24

the angry patient

Answer 24

• identify the reason for or object of their anger
• if its you, attempt to make amends
• if its others, avoid joining in

Question 25

the drunken patient

Answer 25

• introduce yourself in a non challenging way
• do not try to make them lower voice, stop cursing
• maintain clinical objectivity

Question 26

the cognitively impaired patient

Answer 26

• assessment of mental status
• explore level of schooling
• severely impaired, get history from family or friend
• dont be condescending

Question 27

the patient who cannot read

Answer 27

• screen inoffensively
• respond sensitively
• explore remediation

Question 28

hearing impaired patient

Answer 28

partial impairment (lip readers)

• face directly
• speak slowly
• low pitch
• use gestures

address good ear if appropriate
- written questionnaires/conversation if necessary

Question 29

vision impaired patient

Answer 29

• orient patient to the surroundings
• appropriate introduction
• avoid gestures, raising voice

Question 30

language barriers

Answer 30

seek translator, avoid terms that may be difficult to translate, look at the patient, not the interpreter

Question 31

attributions - what the patient thinks is causing their illness

Answer 31

• ideas arise from lay knowledge, cultural beliefs, personal meanings/past experiences
• may assign cause to previous events, behavior/action of others, the physical environment, biological basis of disease

Question 32

attending to attributions

Answer 32

acknowledge and validate patients ideas and incorporate them into an explanation of diagnosis, treatment, and prognosis