IO 1: Approach to the Clinical Encounter IOs Flashcards
(22 cards)
The purpose of the clinical encounter:
To identify and create a plan to address a patient’s presenting problem
What are the components and sequence of a clinical encounter?
- Initiating the encounter (stage, environment, review, agenda, greet & rapport, identify)
- Gathering information (symptoms, pt experience, pt expectation)
- Physical Examination (confirm/exclude, maintain pt comfort & attempt avoid embarrassment, communicate what doing - why, use skills guide w/ confidence)
- Explanation and planning
- Closing the session
What are the principles and integration of the clinician-centered and patient-centered approach to the clinical encounter?
- The clinician focuses on symptoms and getting data to identifying the disease without understanding of individual needs and perspective
- The patient focuses on their perspective of the symptoms and disease, leads without direction, may lack critical biomedical details
What is the difference between disease and illness?
- The disease is the clinician’s explanation to organize the symptoms into a clinical diagnosis
- The illness a construct explaining how the patient experiences the disease and its effects on their relationships, function, and well-being
How is a rapport established at the beginning of the clinical encounter with attention to gender identity, sexual orientation, differences across the lifespan, disabilities or special health needs?
- Be personable and find ways to connect with your patent
- Be professional in the way you present yourself and respectful in the way you address the patient
- Help to make the patient comfortable
- Get on their level and use appropriate verbal and non-verbal communication, keep good eye contact
- In younger patients recruit their parent’s to help their comfort
- Always speak to the adult patient even if there are barriers
- Be considerate of disabilities, speak directly to them
- Use person-first language
- Speak with caregivers secondly and privately
What are the components of establishing rapport?
- Be professional in your appearance
- Give your name and title clearly
- Ask how you are to address the patient
- Make the patient comfortable and seek to connect with them
- Sit at their level and keep eye contact
What are the components of establishing the agenda?
- Identify the patient’s main concern and address that first
- Know how the patient’s feelings, ideas, concern about functioning effects, and end result
What are the components of gathering information?
- Initiate information gathering
- Est pt agenda for encounter
- Invite pt story
- Pt perspective of illness
- ID & respond pt emotional cues
- Explore biomedical perspective
- Background info & context
What are the components of explaining and planning
- Give useful information
- Verify understanding with teach back
- Negotiate plan of Action through shared decision making
1. Choices & options
2. Explore pt preferences
3. Make decision (offering pt more time if needed)
What are the components of closing the clinical encounter?
- Ask “what questions do you have?”
- Confirm understanding: brief summary
- Review who dong what
- Give pt what they need (prescription, instructions)
- When plan should change: get better, no change, gets worse
How should you gather information about the patient’s perspective of illness?
- direct statements, expressed feelings, speech clues (repetition), personal story, behavioral cues (dissatisfaction, repeated visits/second opinion)
FIFE - Feelings: fears/concerns
- Ideas: nature & cause problem
- Function: how effect pt’s function
- Expectations: of disease, clinician, health care
How do you use the teach-back method to assess understanding in the clinical encounter?
- Ask the patient to explain what you have said back to you
What are the social determinants of health?
- Economic stability
- Neighborhood and physical environment
- Education
- Food
- Community, Safety, & Social Context
- Health Care Systems
What is the difference between implicit and explicit bias?
- Implicit: unconscious (affects encounter increasing health disparities)
- Explicit: conscious/deliberate beliefs
What are examples of bias in a clinical encounter?
- Assuming a female PA is a nurse
- Believing all gay males are at a high risk for HIV
What are skills to mitigate bias?
- Reflect on emotion & behavior patterns
- Pause & prepare potential triggers
- Generate alternative hypotheses for biases anchored in behavior
- Practice universal communication & interpersonal skills
- Explore pt’s identities & experiences of bias
- Seek prayer and accountability
What are the three dimensions of cultural humility?
- Self-awareness: learn about your own biases
- Respectful Communication: eliminate “normal” assumptions, learn from patients
- Collaborative partnerships: build pt relationship on respect and mutually acceptable plans
What are spirituality and religion in the context of a clinical encounter?
- Spirituality broader term, focus larger universal themes ie meaning, purpose, transcendence, connection with others
- Religion is a specific beliefs, practices, texts, rituals common to a community in relationship to something larger than themselves
What guided questions can be used to assess the role of spirituality in healthcare?
- What values guides your health care decisions? (religious/spiritual leader/concerns)
- How do your spiritual beliefs and practices influence how you cope with illness and care for yourself? (community/spiritual practices)
- Do you have a spiritual struggle or distress and need referral to a chaplain?
What are the principles to ensure the quality of clinical documentation?
- Clear Organization
- Information contributes directly to assessment
- Pertinent negatives specifically described
- No overgeneralization or omissions
- Not too much detail
- Succinct
- Clear descriptions or images when possible
- Professional tone
What is the purpose of clinical documentation?
- To record what you did for better continuity of care from one visit to another and between providers
What are the seven cardinal features of a symptom?
Onset: when did this start?
L
Duration: how long does an episode last?
Characteristics: how do you experience the symptom
Aggravation/alleviation: Does anything make it better or worse?
Radiation/relieving: Does it move anywhere?
Time: how long has this been going on?
S
