Interviewing and Health History

Question 1

what are two approaches to the interview process

Answer 1

1. patient centered
2. clinician centered

Question 2

patient centered interviewing

Answer 2

following the patients lead to understand their thoughts, ideas, concerns, and requests without adding additional information from the doctors perspective

Question 3

clinician centered interviewing

Answer 3

takes charge of the interaction to meet his or her own need to acquire the symptoms, their details and other data that will help her or him identify the disease

Question 4

what are 10 important features of the interview process

Answer 4

1. respect
2. empathy
3. humility
4. sensitivity
5. attentiveness
6. efficiency
7. factuality
8. validation
9. reassurance
10. sense of partnership

Question 5

ten fundementals of skilled interviewing

Answer 5

1. active listenining
2. empathic responses
3. guided questioning
4. nonverbal communication
5. validation
6. reassurance
7. partnering
8. summerization
9. transitions
10. empowering the patient

Question 6

what are four qualities of an active listener

Answer 6

1. closely attending to what the person says
2. taking into consideration the patients emotional state
3. using verbal and nonverbal skills to encourage the patient to expand on concerns
4. understand the meaning of those concerns

Question 7

six steps in communicating empathy

Answer 7

1. recognize the emotional moment
2. pause to question
3. name the emotion you believe is present
4. communicate your understanding of the emotion and validate is presence
5. respect the patients efforts with the emotion
6. offer support and partnership

Question 8

what are four examples of empathic responses

Answer 8

1. how do you feel about that
2. this really seems to be troubling you, can you say more?
3. that sounds upsetting
4. you must be feeling sad

Question 9

what are four outcomes of establishing an empathic connection

Answer 9

1. reduce anxiety related to isolation and abandonment
2. imporve adherence
3. increase level of patient provider connection
4. reduce PA frustration

Question 10

what are 7 examples of guided questions

Answer 10

1. moving from open ended to focused questions
2. asking questions that require a scaled response
3. asking a series of questions one at a time
4. offering multiple choices
5. asking for clarification
6. encouraging with continuers
7. using echoing

Question 11

what is the goal of guided questioning

Answer 11

facilitate full communication, in the patients own words, without interruption

Question 12

what are two advantages of using guided questioning

Answer 12

1. show interest in the patients feelings
2. can help avoid questions that lead or stifle the patients ideas

Question 13

what are three examples of questions that call for a graded or scaled response

Answer 13

1. what percentage has your rash improved
2. how many stairs can you climb before getting short of breath
3. do you lack the strength for any activities of daily living

Question 14

what does “encouraging with continuers” mean

Answer 14

encouraging the patient to continue speaking through verbal (“yes go on”) or non-verbal encouragement (pausing)

Question 15

echoing (example)

Answer 15

using the patients own words to elicit a more specific response

“i have chest pain”

“did the pain start in your chest?”

Question 16

what two reasons are given 70% as a reason for filing medical litigation

Answer 16

provider communication and attitude

Question 17

paralanguage

Answer 17

qualities of speech such as volume, pacing, tone

Question 18

what are two reasons why summarization important

Answer 18

1. it lets the patient know you were listening
2. it gives you a chance to catch something you might have missed

Question 19

when should transitions be used? (example)

Answer 19

when moving to a new and different part of the interview

“next, I will do a physical exam, so I will step out for a minute while you put on a gown”

Question 20

what are five ways that a provider can empower the patient

Answer 20

1. convey an interest in the person, not the problem
2. reveal the limits of your knowledge
3. elicit and validate emotional content
4. follow the patients leads
5. make your clinical reasoning transparent

Question 21

what are the three phases of a patient interview

Answer 21

1. preparation
2. interview sequence
3. cultural context

Question 22

what are four reasons why is preparation important in the interview

Answer 22

1. reviewing the clinical record
2. setting goals
3. reviewing my apperance and behavior
4. adjusting the enviroment

Question 23

what are the ten steps in the interview sequence

Answer 23

1. greeting and rapport
2. establishing an agenda
3. inviting the patient story
4. exploring the patient perspective
5. idenifying and responding to emotional cues
6. expanding and clarifying the patient story
7. generating and testing diagnostic hypothesis
8. sharing the treatment plan
9. closing the interview
10. self reflection

Question 24

rapport

Answer 24

a feeling of relationship, trust, empathy

Question 25

what are four ways to help build rapport

Answer 25

1. greet the patient by name 2. use formal titles 3. explain your role as a provider 4. acknowledge and greet family members

Question 26

what are three positional considerations helpful when building rapport

Answer 26

1. sit at eye level 2. positioned several feet from the patient 3. remove physical barriers like bed rails

Question 27

what are some good ideas when establishing the agenda

Answer 27

1. ask if there was anything special that brought them in 2. identify all concerns early in the interview 3. ask summative questions at the end to bring problems out of the woodwork

Question 28

what is the disease/illness distinction model

Answer 28

the idea that "disease" is a way for the provider to organize symptoms to guide diagnosis, while "illness" evaluates how a disease affects a person life experience and emotional state

Question 29

what is the FIFE pneumonic

Answer 29

* **feelings** about the illness * **ideas** about what is causing the illness * ways the problem is impairing **function** * what the patients **expectations** are regarding their health and care

Question 30

what are the seven attributes of a symptom

Answer 30

1. location 2. quality 3. quantity/severity 4. timing 5. onset 6. remitting/exacerbating factors 7. associated manifestations

Question 31

what is the FIFE pneumonic used for

Answer 31

to help ask questions to understand a patients perspective

Question 32

what is an important consideration when generating differential diagnosis

Answer 32

to avoid making a snap decision about what the diagnosis is

Question 33

what is the cone analogy used to describe

Answer 33

the process of describing a symptom with open ended questions first, then more specifc questions

Question 34

what are the three steps in sharing the treatment plan

Answer 34

1. introducing choices 2. exploring the patient preferences 3. moving to a decision

Question 35

if a treatment plan requires change that a patient is resistant to, what are three methods motivate new behavior

Answer 35

1. ask open ended questions about why a person might change 2. listen to the patients experience 3. provide information with their permission

Question 36

why is self reflection imporant

Answer 36

it allows the interviewer to think critically about how they might improve

Question 37

why is it necessary for an interviewer to put the patient interview into a cultural context

Answer 37

many cultures have unique beliefs about health and medicine that need to be respected

Question 38

what are three dimensions of cultural humility

Answer 38

1. self awarenes 2. respectful communication 3. collaborative partnerships