Define patient centered interviewing
A more bio-phychosocial approach to patient care and management
2 skills for facilitating patient centered interviewing
open ended questions and relationship building skills
Ways to encourage open ended questions? Non focused and focused
Non focusing question skills:
Silence, non-verbal encouragement, neutral utterances
Focusing question skills:
Echoing, open-ended requests, summarizing or paraphrasing
Relationship building skills for patient centered interviewing….NURS?
Empathy skills: NURS Naming Underscoring Respecting Supporting
Be able to pick out a sentence that reflects this skill
What are direct relationship building skills?
Ask your patient how they feel
What are indirect relationship building skills?
self-disclosure, impact of problem, patient’s explanation
Summary of patient centered interviewing
Setting the stage, obtain chief complaint, open chief complaint, continue chief complaint, transition to clinician centered interview
What are 5 positive non-verbal communication gestures?
Leaning forward in the seat/tilt of the head, nodding head and hand to cheek, smiling, relaxed/open palms, sitting with legs apart
Lack of eye contact resembles what?
in some cultures respect
in other cultures intimidated, disrespectful, dishonest
There are many negative gestures in non verbal communication
Some include hands on hips, biting nails, looking at objects(disinterested) sitting with legs crossed foot kicking slightly, head resting in hands, eyes downcast, looking down, face turned away, pulling at ear, grimace/sighing, touching/slightly rubbing nose, rubbing the eye, fidgeting, hands clasped behind head or back and locked ankles, crossed arms or legs, pinching bridge of nose, eyes closed, tapping or drumming, patting/fondling hair, backward lean, and hand near ear….whew that’s pretty much all of them
Rubbing hands, stroking chin, taking a sip to drink, biting frame of glasses, cleaning eye glasses, scratching head
What is a subjective finding?
Anything the patient says, discloses or has symptoms of
What is an objective finding?
Anything that can be measured, observed, or experienced by you as the doctor
What is LOCQSMATT?
L-location O-onset C-chronology Q-quality S-severity M-modifying factors A-associated symptoms T-treatment previous T-treatment goal
What is the definition of a differential diagnosis(DDX)?
A systematic diagnostic method used to identify the presence of a disease/condition where multiple alternatives are possible
In short a DDX is?
essentially a process of elimination or at least of obtaining information that shrinks the probabilities of competing diseases/conditions to negligible levels
What is the subjective portion of your patient evaluation?
LOQSMATT-typically in the history portion of the evaluation
What is the objective portion of the evaluation?
Visual, auditory, olfactory, palpatory- Typically in the physical exam but also occurs in the history(observation of the patient)
What are the 5 steps in the UWS violence protocol?
1) Identify the intimate partner violence (IPV) survivor
2) Ask about the abuse(with sample questions)
3) Respond to the disclosure of abuse
4) Chart appropriately
5) Schedule follow up with patient
What is the UWS statement for asking new patients about domestic violence?
“Because violence is so common in many peoples lives, we’ve begun to ask all of our new patients about it”
‘Are you currently or have you ever been in a relationship where you were physically hurt, threatened or made to feel afraid?”
When does the doctor patient relationship begin?
The relationship between a physician and his or her patient is created when the patient knowingly seeks the services of the physician, and the physician knowingly accepts him or her as his patient
What are some examples of personal boundaries?
Maintaining proper physical distance, not touching clients in an inappropriate manner or one that can be misconstrued, failure to see the patient as a patient, never assume to know another persons boundaries unless they tell us, boundaries are unique to each person, proceed carefully, when in doubt ask
What are some examples of when you have overstepped your boundaries with a patient?
You complain to patients about: other patients or staff members
You complain about your own aches, pains, and illnesses
You accept gifts from patients
You react with anger toward a patient
You feel compelled to “fix” a patients problem more than the patient does
You talk to patients about your personal life in depth
You tell patients where you live and give them your phone number or visit patients in their homes as a friend not in your professional capacity
You plan activities with patients outside the unit
What are 3 barriers or “road blocks” to good to good listening?
Judging, suggesting solutions, avoiding the others concerns
What exactly is judging?
The natural tendency to evaluate from your own personal frame of reference and judge what someone else is saying
What are some examples of suggesting solutions that would be inappropriate?
Rescuing/advising-takes away from their experience
Threatening-scaring patient into action
Moralizing-deciding something is good or bad ie. smoking, not exercising, eating poorly
Excessive/inappropriate questioning-staying on a patients case around diet, exercise,smoking cessation
Ways that others concerns are avoided?
Diverting-changing the subject when emotions arise
Logical argument-convincing pt that their concern is foolish or problem is not that bad
Reassuring-telling patient everything will be ok and a solution/cure will be found
Remember to study HW assignments on charting errors and legal assignments
As kaminski would say “Happy Trails”
That was for you Julie:-)