(3) Interviewing & Health History Flashcards
Skilled interviewing is both:
patient-centered (patient symptoms) and clinical-centered (interpret)
Skilled interviewing techniques
active listening empathetic responses guided questioning nonverbal communication validation reassurance partnering summarization transitions empowering the patient
techniques of guided questioning
- moving from open-ended to focused questions
- using questioning that elicits a graded response
- asking a series of questions, one at a time
- offering multiple choice for answers
- clarifying what the patient means
- encouraging with continuers
- using echoing
empowering the patient: techniques for sharing power
- evoke the patient’s perspective
- convey interest in the person not just the problem
- follow the patient’s leads
- elicit and validate emotional content
- share information with the patient, especially at transition points during the visit
- make your clinical reasoning transparent to the patient
- reveal the limits of your knowledge
Interview Preparation
- review clinical record
- set goals for interview (balance patient-centered goals with provider-centered goals)
- reviewing your clinical behavior and appearance
- adjusting the environment
Disease/Illness Distinction Model
Disease = explanation that the clinical uses to organize symptoms that leads to a clinical diagnosis
Illness = construct that explains how the patient experiences the disease, including its effects on relationships, function, and sense of wellbeing
(Clinical interview needs to incorporate both these views of reality)
FIFE: Exploring the Patient’s Perspective
- the patient’s FEELINGS including fears or concerns about the problem
- the patient’s IDEAS about the nature and the cause of the problem
- the effect of the problem on the patient’s life and FUNCTION
- the patient’s EXPECTATIONS of the disease, of the clinician, or of health care, often based on prior personal or family experiences
mnemonic for responding to emotional cues
Name Understand Respect Support Explore
2 mnemonics for 7 attributes of a symptom
OLD CARTS
Onset, Location, Duration, Character, Aggravating/Alleviating Factors, Radiation, Timing, Severity
OPQRST
Onset, Palliating/Provoking Factors, Quality, Radiation, Site, Timing
Shared decision making
- pinnacle of patient-centered care
3 step process:
- introduce choices and describe options using patient decision support tools when available
- explore pt preferences
- moving to a decision, checking the pt is ready to make a decision and offer more time if needed
guiding style of motivational interviewing
- “ask” open ended questions - pt consider how Andy they might change
- “listen” to understand patient’s experience, “capture” their account with brief summaries or reflective listening statements
- “inform” ask permission to provide info, ask implications for pt
cultural competence
a set of attitudes, skills, behaviors, and policies that enable organizations and staff to work efficitively in cross-cultural situations
Cultural Humility
process that requires humility as individuals continually engage in self-reflection and self0critique as lifelong learners and reflective practitioners
Culture
the system of shared ideas, rules, and meanings that influences how we view the world, experience it emotionally, and behave in relation o other people
-broader than ethnicity
3 dimensions of cultural humility
- self awareness (know bias)
- respectful communication (eliminate assumptions about normal)
- collaborative partnerships (build on respect and mutually acceptable plans)
Values
standards we use to measure our own and others’ beliefs and behaviors
