Medical Encounter and Clinical Decision Making

Question 1

Medical Encounter and Clinical Decision Making Overview, name some aspects

Answer 1

1. Rapport
2. Two types of clinical reasoning
3. Questions to avoid
4. 8 data gathering techniques

Question 2

Is rapport bidirectional?

Answer 2

yes

Question 3

Is therapeutic rapport bidirectional?

Answer 3

no

Question 4

In an interview what is a key thing you should pursue???

Answer 4

pursue feelings over facts

Question 5

Name some aspects of rapport

Answer 5

1. Rapport –> state of mutual confidence and respect between 2 ppl.
2. Sensitivity to emotions
3. Cultural Appropriateness
4. Establishing limits of confidentiality
5. Attentive listening
6. Touching
7. Influenced by MD behavior
8. Increases likelihood of disclosure
9. Increases likelihood of compliance or acknowledgement of non compliance

Question 6

What is the therapeutic alliance?

Answer 6

1. Powerful tool to benefit patients
2. A major component of the placebo response (patients responded to placebo treatment because they received some form of treatment by seeing the doctor)
3. In some psychiatric illnesses it may be more powerful than biological treatment

Question 7

What are the two types of reasoning?

Answer 7

1 .Non-analytical –> previous experience and other intrinsic factors enable clinician to quickly understand and make correct decisions
2. Analytical–> deliberate and thoughtful consideration of all aspects of case is required for correct decisions

Question 8

What types of questions should you ask the patient?

Answer 8

1. open ended questions
2. Direct questions
3. Leading questions

Question 9

What are the three defense mechanisms in illness?

Answer 9

1. Denial
2. Regression
3. others

Question 10

What are the seven interview techniques?

Answer 10

1. Support
2. Empathy (transient emotional resonance)
3. Validation
4. Facilitation
5. Reflection
6. Confrontation
7. Recapitulation

Question 11

Open ended questions can quickly elicit, what?

Answer 11

1. Major concern or most pressing or potentially serious problem
2. Triggering events that led patient to seek help
3. Attributions or explanatory models for symptoms
4. Expectations about what can/should be done

Question 12

What types of questions should you avoid?

Answer 12

1. Compound questions
2. Leading questions
3. Close-ended questions

Question 13

What are the eight data gathering techniques?

Answer 13

1. Nonverbal techniques
2. Checking
3. Clarification
4. Interruption
5. Transition
6. Reflection
7. Information
8. Giving Directions

Question 14

What percentage of patients will not do what they are told?

Answer 14

50%

Question 15

What are the six steps in clinical decision making process?

Answer 15

1. Defining the problem
2. Defining outcome goals
3. Generating alternative solutions
4. Selecting the best solution
5. Implementing solution
6. Evaluating outcome

Question 16

What are eight sources of error in clinical decision making?

Answer 16

1. Theoretical and personal biases of patient/provider
2. Diagnosis by formula
3. Optimism/Pessimism
4. Too many hypotheses
5. Oversimplification
6. Reorganizing the abnormal (explain trivial factors then complex disease processing) (dont pathologize the normal)
7. Provider-patient interactions
8. Mistaking correlation for causation