Week 1 - Approach to Clinical Encounter Flashcards
The interviewing process
- Active listening
- Guided questioning (open–>closed ended)
- Summarization
- Transitions (pt knows what to expect)
o Partnering - Validation/empowering
- Reassurance
Types of interviewing techniques
Patient centered
- Patient’s concerns, feelings and emotions
Provider centered
- clinician takes charge of the interaction to meet own needs to acquire symptoms, details, or other data to diagnose the disease
Setting the stage for examination
- Adjust environment for comfort
- Review clinical record
- Set your agenda – clarify goals
Establishing rapport
- Feeling of connectedness
- Making them feel deeply heard and understood
- Explain your role in their care
Illness
Patient’s experience of their symptoms
FIFE Model
Feelings (fears, worries)
Ideas (what may have caused illness, what does the pain mean, what is going on?)
Functional effect (how does this affect QOL, people in life, day to day effects)
Expectations (what can the provider do, expectations, hopes)
Fundamentals of skilled interviewing
- Active or attentive listening
- Guided questioning
- Empathic responses
- Summarization
- Transitions
- Partnering
- Validation
- Empowering the patient
- Reassurance
- Appropriate verbal communication
- Appropriate nonverbal communication
People first language
- Person with substance use disorder vs. drug abuser
- Person diagnosed with schizophrenia vs. schizophrenic
- Person living with HIV vs HIV patient
Verbal communication
- Use understandable language (avoid jargon, communicate only essential information)
- Use short simple sentences, clear concrete words and phrases
Nonverbal communication
- Eye contact
- Calm and unhurried
- Positive, professional regard
- Read the patient’s nonverbal cues
- Mirror patient posture to help form connection
Challenging patient situations and behaviors
Silent
- may be therapeutic, collecting thoughts, “what are you thinking about”
Talkative
- Allow to talk 5-10 min uninterrupted, focus on what is most important for patient, summarize, use more focused questions
With confusing narrative
- Use guiding questions, clarification, summarization
With altered state or cognition
-Seek family to assist
With emotional lability
-Provide support, allow crying
Angry or aggressive
- Acknowledge situation, validate feelings without agreeing, actively listen, try to understand patient
Flirtatious
- Set clear boundaries
Discriminatory
- Set clear boundaries
- Assess illness acuity of patient, cultivate therapeutic alliance
With hearing loss
- Use aids, sit on hearing side
With low or impaired vision
- Wear glasses, use verbal explanations
With limited intelligence
- Mini mental exam
Burdened by personal problems
- Look at pros and cons rather than giving advice, what other options have been considered
Nonadherent
- Use reminders, emails, letters, forms, simplify dosing schedule, alter management plan
- Ask about reading, be sensitive
With low health literacy/ With limited language proficiency
-Medical interpreter
With terminal illness or dying
- Effective communication on needs
Focused assessment
- Address focused concerns/symptoms
- Restricted to specific body system
- Applies exam relevant to the concern
Comprehensive Assessment
Components:
- Patient information
- CC
- HPI
- PMH
- FH
- PSH
- ROS
Focused assessments used for
- Patients seeking care for a specific concern
- Ongoing care for chronic problems
- Health maintenance visits
Comprehensive assessment used for
- New patients in most settings (office, hospital)
