Patient Centered Interviewing Flashcards
(47 cards)
What is the purpose of medical interviewing?
- to gather information
- to establish a safe atmosphere & trusting relationship w/ the pt
- to provide pt education (inform & motivate the pt)
What does the biomedical model focus on?
biological factors
How does the biomedical approach define health?
as the ‘absence of disease’
What does the biopsychosocial model connect?
connects biological factors w/ psychological & social
What does the biopsychosocial model allow for?
increased understanding of illness & health
What was the rationale for improving medical interviewing?
- patients often seek care due to their experience, not their symptoms
- patients often have more than one concern
- being able to tell one’s symptoms story is diagnostically useful + therapeutic
What do we need to balance when doing medical interviewing?
- improve experience of their symptoms
- translate symptoms into a diagnosis
What are the attributes of patient-centred interviewing skills?
- patient leads interaction
- allows patient to express importance / expectations
- interview to elicit experience of disease (symptoms + personal concerns, feelings and emotions)
- typically uses open-ended questioning
- builds and maintains clinician-patient relationship
What are non-focusing open-ended data-gathering skills?
- silence
- nonverbal encouragement (eye contact, hand gestures, leaning forward)
- continues (e.g., “uh-huh”)
What are focusing open-ended data-gathering skills?
- echoing (repeating a word or phrase the patient has said)
- requesting (“go on,” “tell me about the pain”)
- summarizing (paraphrasing your understanding of what the patient has said)
What are 4 interviewing skills?
- open-ended data-gathering skills
- closed-ended data-gathering skills
- emotion-seeking skills
- conveying-empathy skills
What are components of closed-ended data-gathering skills?
- questions that produce yes/no answers
- questions that produce brief responses
- multiple-choice questions
What are components of emotion-seeking skills?
- direct inquiry (e.g., how did that make you feel)
- indirect inquiry: inquiring about impact, eliciting beliefs or attributions, intuiting how patient might be feeling, asking about trigger
What are components of the conveying-empathy skills?
- name the feeing/emotion
- understand statement
- respect
- support
What is step 1 of the integrated medical interviewing?
setting the stage
How long does “setting the stage” take?
30-60 second
What are components of “setting the stage”?
- Prepare for patient consult by reading intake form/chart to familiarize yourself with patient’s problem list, medications, allergies and relevant past medical history
- Welcome/ greet the patient
- Use patient’s name
- Introduce yourself and identify specific role
- Ensure patient readiness and privacy
- Address barriers to communication (sit down)
- Ensure comfort and put patient at ease
What is step 2 of the integrated medical interviewing?
elicit chief concern + set agenda
What are components of the elicit chief concern + set agenda step of the integrated medicla interviewing?
Indicate time available.
Forecast what you would like to happen during the interview.
Obtain a list of all issues the patient wants to discuss (e.g. specific symptoms, requests, expectations, understanding)
Summarize and finalize the agenda (negotiate specifics if too many agenda items)
What is step 3 of the integrated medial interviewing process?
opening the history of present illness (HPI)
How long should opening the history of present illness (HPI) take?
30-60 seconds
What are components of step 3 opening the history of present illness (HPI) that help the patient lead the conversation?
Start with open-ended questions/statements
Use non-focusing open-ended skills (attentive listening)
Obtain additional data from non-verbal sources: physical characteristics, autonomic changes, accoutrements, environment and self
What are non-verbal information we can receive in of step 3 opening the history of present illness (HPI)?
- Physical characteristics: general health, skin and hair colour, odor, deformities, habitus (emaciated, disheveled, “uremic” breath, jaundice, amputated lef, kyphoscoliosis)
- Autonomic changes: heart rate, skin colour, pupil size, skin moisture, skin temperature
- Accoutrements or accessories: clothing, jewelry, eyeglasses, make-up (e.g. expensive jewelry, thick eye glasses, tattoos and body piercings, no make-up or poorly applied make-up)
- Environment: hospital (greeting cards, flowers, photographs)
- Self: aware of your own emotions and reactions to patients
What is the 4th step of integrated medical interviewing?
learn patient experience of illness
