midterm study guide

Question 1

Define patient centered interviewing

Answer 1

A more bio-phychosocial approach to patient care and management

Question 2

2 skills for facilitating patient centered interviewing

Answer 2

open ended questions and relationship building skills

Question 3

Ways to encourage open ended questions? Non focused and focused

Answer 3

Non focusing question skills:
Silence, non-verbal encouragement, neutral utterances
Focusing question skills:
Echoing, open-ended requests, summarizing or paraphrasing

Question 4

Relationship building skills for patient centered interviewing….NURS?

Answer 4

Empathy skills: NURS
Naming
Underscoring
Respecting
Supporting

Be able to pick out a sentence that reflects this skill

Question 5

What are direct relationship building skills?

Answer 5

Ask your patient how they feel

Question 6

What are indirect relationship building skills?

Answer 6

self-disclosure, impact of problem, patient’s explanation

Question 7

Summary of patient centered interviewing

Answer 7

Setting the stage, obtain chief complaint, open chief complaint, continue chief complaint, transition to clinician centered interview

Question 8

What are 5 positive non-verbal communication gestures?

Answer 8

Leaning forward in the seat/tilt of the head, nodding head and hand to cheek, smiling, relaxed/open palms, sitting with legs apart

Question 9

Lack of eye contact resembles what?

Answer 9

in some cultures respect

in other cultures intimidated, disrespectful, dishonest

Question 10

There are many negative gestures in non verbal communication

Answer 10

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

Question 11

Neutral behaviors

Answer 11

Rubbing hands, stroking chin, taking a sip to drink, biting frame of glasses, cleaning eye glasses, scratching head

Question 12

What is a subjective finding?

Answer 12

Anything the patient says, discloses or has symptoms of

Question 13

What is an objective finding?

Answer 13

Anything that can be measured, observed, or experienced by you as the doctor

Question 14

What is LOCQSMATT?

Answer 14

L-location
O-onset
C-chronology
Q-quality
S-severity
M-modifying factors
A-associated symptoms
T-treatment previous
T-treatment goal

Question 15

What is the definition of a differential diagnosis(DDX)?

Answer 15

A systematic diagnostic method used to identify the presence of a disease/condition where multiple alternatives are possible

Question 16

In short a DDX is?

Answer 16

essentially a process of elimination or at least of obtaining information that shrinks the probabilities of competing diseases/conditions to negligible levels

Question 17

What is the subjective portion of your patient evaluation?

Answer 17

LOQSMATT-typically in the history portion of the evaluation

Question 18

What is the objective portion of the evaluation?

Answer 18

Visual, auditory, olfactory, palpatory- Typically in the physical exam but also occurs in the history(observation of the patient)

Question 19

What are the 5 steps in the UWS violence protocol?

Answer 19

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

Question 20

What is the UWS statement for asking new patients about domestic violence?

Answer 20

“Because violence is so common in many peoples lives, we’ve begun to ask all of our new patients about it”
or
‘Are you currently or have you ever been in a relationship where you were physically hurt, threatened or made to feel afraid?”

Question 21

When does the doctor patient relationship begin?

Answer 21

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

Question 22

What are some examples of personal boundaries?

Answer 22

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

Question 23

What are some examples of when you have overstepped your boundaries with a patient?

Answer 23

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

Question 24

What are 3 barriers or “road blocks” to good to good listening?

Answer 24

Judging, suggesting solutions, avoiding the others concerns

Question 25

What exactly is judging?

Answer 25

The natural tendency to evaluate from your own personal frame of reference and judge what someone else is saying
Labeling
Criticizing
Diagnosing(too soon)

Question 26

What are some examples of suggesting solutions that would be inappropriate?

Answer 26

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

Question 27

Ways that others concerns are avoided?

Answer 27

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

Question 28

Remember to study HW assignments on charting errors and legal assignments

Answer 28

As kaminski would say “Happy Trails”

That was for you Julie:-)