2 – History Flashcards
1
Q
What are the 2 approaches to organizing clinical information?
A
- Problem oriented approach
- Pattern Recognition
2
Q
Problem oriented approach general
A
- Exhaustive and systematic collection of info through history and physical exam followed by integration and analysis of database
3
Q
What are the 4 steps to a problem orient approach?
A
- Start with database assembly
- Leads to problem ID with DDx proposed for each problem
- Plan to rule in/out proposed differentials and initiate treatment based on your working diagnosis
- Assessment and re-evaluation: during hospitalization or follow-up appointments
4
Q
Problem oriented approach pros
A
- Minimize errors
- Train new professionals
- Solve complex cases
- Communicate effectively
- Document appropriately
5
Q
Problem oriented approach cons
A
- Inefficient in terms of time
o Maybe not ideal for general practice or first opinion care
6
Q
Pattern recognition general
A
- Immediate integration of into to ID most probabilistic diagnosis used by experienced clinicians
7
Q
Pattern recognition pros
A
- Catches majority of common problems
- Efficient
8
Q
Pattern recognition cons
A
- Common problems can present in unusual ways
- Uncommon problems can present like common problems
- Miss out on complete history and lead to miss diagnosis
- Jump to conclusions
9
Q
What is our data base? What does it consist of?
A
- Systematic approach to collect info=critical to solve clinical problems
- History
- Physical examination
- Dynamic, yet consistent=paramount to assemble history
- *allows clinicians to ID problems and make DDx
10
Q
Getting history when you have a problem visit
A
- Presenting complaint: need to understand owner’s expectations and address it
- Get thorough history: open-ended questions and body systems review (2.5-3mins), the closed end to ‘funnel’
- General or background history
o General health, past medical problems and conditions in which the animal lives
- General or background history
11
Q
Getting history when you have a preventative medicine visit
A
- Get general or background history
- Problem specific inquiry
o Presenting complaint: may not have a specific one
o Thorough history: open end to then closed end to ‘funnel’, body systems review
12
Q
What are some history taking tips?
A
- Always discus with the person who is MOST familiar with the day to day care of pet
- Ask if they caught their concerns in video or pictures
- Adopt a consistent method for taking a history
13
Q
What are some communication tips?
A
- Beginning: open ended inquiry (describe Max’s coughing), AVOID closed ended inquiry (Is max coughing?)
- Summarizing back to them
- Avoid leading questions (was the vomit bloody?)
- Get them to describe what they have seen, rather than their interpretation (vomiting vs. regurgitation)
- Follow up with closed ended questions if needed
o Details that were missing and an opportunity to speak first and feel heard - For specific systems can ask closed ended questions for specifics
14
Q
Establishing the time frame
A
- Clinical curve can help you prioritize DDx when using problem orient approach to vet med
o Traditionally associated with neurological DDx
o Peracute: blood clot
o Acute: lots
o Subacute: inflammatory or infectious
o Chronic: neoplasia or degenerative disorders
15
Q
Body system review: another approach
A
- Go through each body system
- Memory and use physical exam form in medical record as a checklist or guide
16
Q
What are some important aspects of a past medical history?
A
- Vaccination: type and dates
- Deworming
- Flea/tick and heartworm prevention
- Major medical or surgical problems
- Nutrition
- Supplements
- Medications and dosages
- Husbandry
17
Q
What are the 5 animal welfare freedoms?
A
- Freedom from hunger and thirst
- Freedom from discomfort
- Freedom from pain, injury or disease
- Freedom to express normal behaviour
- Freedom from fear and distress
18
Q
Front desk and waiting room: things to consider
A
- First few minutes meeting a vet will shape the nature of their future contact
- Want to make a good first impression
o Staff, ID by name and pronoun, ask for clarification
o Visual presentation
o Minimize wait times and acknowledge wait time
o Entertainment: WiFi magazines, coffee/tea
19
Q
Appointment: things to consider
A
- Call by name and know sex
- Accept what they saw about their pet or the breed without question
- Dedicate time to pet and client (10-15min history)
- Nonverbal communication=90% of communication
20
Q
Client connection
A
- Connect on a personal level before you connect on a professional level
- If you know specific info about the pet, then use it
- Set a professional tone
o Appearance and demeanor
o Clean workspace
o Remain still and appropriate eye contact
o Take away barriers - Develop an understanding of the client’s relationship to the animal (owner, trainer, etc.)
21
Q
Patient connection
A
- Fear free principles
o Notes on behaviour
o Sedation or muzzles
o Gabapentin or trazadone
22
Q
What are 2 things that help keep the client in the loop?
A
- Reflective listening
- Summarizing
- Sign posting: review and outline next steps
*then tell the owner what you recommend in order to investigate the possible underlying cause
-don’t prejudge clients financial means
-negotiate if recommendations are not acceptable
23
Q
How can I get all the info when dealing with a chatty person?
A
- Polite interruptions
o “thank you for all the important info. I was hoping you could tell me more about….”
24
Q
Ending the appointment
A
- Summarize
- Establish when next point of contact will be
- Shake owners hand to conclude visit and walk them up to reception area
- Don’t leave client in a room or wandering up front with UNCLEAR instructions as to what happens next
