DocCom Modules 5,6,7,8 Flashcards
Integrated patient-centered and doctor-centered interviewing
Provides more accurate medical diagnoses than isolated doctor-centered interviewing
Which one of the following is not one of the 7 cardinal features of a symptom?
Attribution
An empathic response to a patient distraught about a new diagnosis of breast cancer might be
I can understand; this news is devastating for you.
Which of the following statements about disease and illness is most accurate?
Illness is a patient’s experience of disease.
Mr. Jones, age 50, comes to the office and says he is worried about his cough. You ask “Please tell me more about this?” Which of his statements about his situation is likely to emerge earlier than the others?
I was treated with antibiotics last month for this cough and it didn’t help.
Mr. J has come to your office for a new patient visit. The process of patient-centered interviewing suggests that early in the interview, after introducing yourself and ensuring that he is comfortable, you should say:
“Tell me what is on your mind today. … What else?”
Which of the statements below is most accurate about the process of patient-centered interviewing?
It prompts patients to offer psychosocial details
A new patient in your office, Mr. Smith told you his concerns, and said that his biggest concern is a recent episode of chest pain; he appears quite anxious. Your next best step toward completing the history of present illness is to say
“You look worried.”
For your patient who is concerned about chest pain, which informational statement will be included in the History of Present Illness (HPI)?
This burning chest pain started after I had a bowl of chili.
Ken Fortek is a 40 year old divorced Caucasian book keeper who complains of persistent headaches. You’ve done a careful history, physical exam, and ordered laboratory tests. Your exam and lab results are normal. You convey this good news but your patient continues to look worried. He asks, “How can you be sure that these headaches are not related to a brain tumor?” Which of the following responses would best illustrate Attentiveness and Warmth?
D. State “I can see that you are still worried about the possibility of a brain tumor. Help me understand why that is the case.”
Peter Erman is 18, a Caucasian high school student admitted to the hospital for internal injuries after driving a car into a tree. He was driving while intoxicated, and luckily no one else was injured. It is your responsibility now to address the drunk driving issue with him. Which of the following responses would best convey Support?
State: “There are many situations that can result in someone driving while they are drunk. I would like to help you figure out what led to your accident so that you can avoid it in the future.”
Francine Bacon is a single mother of 3 school-aged children. She is 38, African American, overweight and has hypertension. She is an office manager and some of her supervisees are performing poorly. Balancing home and work demands is difficult. You have discussed weight loss strategies and she agreed to start a medication for her blood pressure. When you tell her that today neither her blood pressure nor her weight has changed, she responds “I have been following your instructions and made a lot of changes. But this plan clearly does not work for me.” Which of the following responses would best illustrate Partnership?
State “You are coping with a lot of challenges. Let’s see if we can devise a new plan that won’t add to your stress levels.”
Francesca Chen is 35, a Chinese American hairdresser with diabetes. Her glucose and HgbA1C indicate poor control. As you speak, she hesitatingly reveals that since the last visit two months ago, she broke up with her boyfriend of 10 years, started a new job and registered for classes at the local community college. Which of the following statements would show that you understand and empathize with her likely emotional state?
State “As you speak, I get the sense that the many changes in your life are very stressful.”
Carlos Rodriguez is 60, Hispanic, owns a neighborhood grocery store, and is in the hospital with a heart attack. His condition has improved and he wants to be released immediately, even contemplating signing out against medical advice. Mr. Rodriguez is in bed, with IV’s running. He tells you he is concerned that his store is his wife’s responsibility while he is in the hospital, and she is undergoing outpatient treatment for breast cancer. Which of the following responses would best convey Partnership?
State “Many people in your situation would feel hesitant to stay longer in the hospital. Let’s work together to make sure that you are stable enough to return home.”
Israel Wasserman, a 50 year old Caucasian teacher, was brought to the hospital after experiencing a seizure while shopping. You found that he has a benign brain tumor and recommended that he start treatment immediately to prevent further seizures. Israel has trouble accepting the diagnosis and wants to postpone treatment because he fears that any delay in launching a big project at school may derail the entire project. Which of the following statements best conveys Respect?
State: “I admire your devotion to your work, and I’m sure your students appreciate all you do for them.”
James King, 70, is a patient of your colleague on vacation and a retired African American postal worker. His daughter brings him in today because of difficulty breathing and a fever. You recommend hospitalization, but Mr. King wants to wait until his regular physician returns in a few days. Which of the following responses would best convey Attentiveness and Warmth?
State: “I can see that you are anxious about going into hospital without having your regular physician at your side. Please tell me more about your concerns.”
Juanita Perez, 21, is a single college student of Hispanic descent. Juanita came in with gastrointestinal symptoms, you suspected pregnancy, and confirmed the diagnosis by lab test. You noticed arm bruises consistent with physical abuse. When you told Juanita she was pregnant, she started to cry. Which of the following responses would best convey Support?
State: “I can see that being pregnant is very upsetting to you. How can I help you?”
This is your first encounter with Margot Gwen, a 20 year old single Caucasian collegian with Crohn’s disease whose previous physician just moved out of town. Her responses to your open-ended questions (“Tell me a little about yourself;” or “I’ve looked at your medical record, how can I help you today;” etc.) are consistently one or two word answers, and she looks down at her hands and twists her fingers during the interview. Which of the following responses would best illustrate Empathy?
State: “You seem uncomfortable with our conversation, so far.”
Renata Bowen, an 80 year old widow and retired antiques dealer was brought to the hospital for a hip fracture. Her rehabilitation is going more slowly than usual, and she will clearly need long-term care for an uncertain period. Ms. Bowen has maintained her independence throughout life, and the idea of going to a nursing home (even temporarily) seems unacceptable. Her mood has been depressed, and her social worker reported that Ms. Bowen cried when he brought up the issue. After greeting her, what statement would best demonstrate Respect , as you begin today’s conversation?
State: “I am so impressed with your ability to lead a remarkably independent life until now.“
Typically, clinicians begin interviews by inquiring about what concerns brought the patient into the office. On average, clinicians interrupt the patient’s opening statement after 18-23 seconds, and seldom return to asking the patient for a complete list of concerns. The most likely result of this pattern of limiting the list of concerns in opening the discussion is to:
Increase the frequency of late-arising concerns.
Your patient, a 54 year old woman, returns to your office for a blood pressure follow-up. In response to your opening question, “What concerns do you have today?” the patient mentions back pain and begins to give details about the most recent painful episode. You can best facilitate addressing all of the important concerns for the visit today by which of the following:
Allow the patient to complete her statement about the recent painful episode, then ask “In addition to your back pain, is there anything else?”
Ms. S., a 23 year old, returns to your office for an oral contraceptive follow-up visit. She has been having increasingly frequent headaches with nausea and vomiting, and tells you she thinks she has a brain tumor. She also has low back pain. She wants an MRI of her brain and her back, pain medications, a note for her supervisor, a referral to a neurologist at another hospital, and a refill of her oral contraceptives. She indicates her agreement with your summary of her complete list of concerns for this 20 minute office visit. What is your best statement to Ms. S. to help you reach agreement on the agenda for the remainder of the visit?
“Let’s start with more discussion about your headache symptoms and an exam so we can decide what tests and referrals might be needed.”
“I know that you are concerned about losing weight. I’d like to be sure I know the other things that are on your mind.”
Which of the following communication skills used in opening the discussion best describes the physician’s statement?
Survey symptoms
“You mentioned that your wife is having health problems. Let’s get back to how that is affecting you.”
Which of the following communication skills used in opening the discussion best describes the physician’s statement?
Redirect patient
