6. Communication Challenges

Question 1

5 Steps for patient-centered interview

Answer 1

• Step-1 Set the stage for interview (30-60 sec.) and introduce yourself to everyone
• Step-2 Elicit CC and set agenda (1-2 min)
• Step-3 Begin the interview with non-focusing skills so patient can express themselves (30-60 sec.)
• Step-4 Use focusing skills to learn 3 things (3-10 minutes)
  
  • 1) Symptom Story,
  • 2) Personal Context,
  • 3) Emotional Context
• Step-5 Transition to Middle of the interview => clinician-centered phase (30-60 sec.)

Question 2

How can we set the stage for the interview in 30-60 seconds?

Answer 2

1. welcome pt
2. use their name and ask how they want to be addressed
3. introduce yourself and role
4. ensure pt is ready, privacy and comfort
5. sit down to remove barries to communicatio

Question 3

How can we elicit CC and set agenda for the interview in 1-2 min?

Answer 3

1. Indicate time
2. Set agenda for what you want to happen
3. Have a list of ALLLLL issues pt wants to discuss
4. Summarize and finalize agenda

Question 4

if too many agenda items =>

Answer 4

negotiate specifics

Question 5

How can we use non-focusing skills to help pt express themselvs in in 30-60 sec?

Answer 5

1. Open ended questions
2. Attentitive listening
3. Pay attn to non-verbal cues

Question 6

How can we use focusing open-ended skill to create a symptom story?

Answer 6

1. Echo: repeat pts words “you refer to it as BAD pain”
2. Request: “that sounds imp; go into mO FUCKN DETAIL”
3. Summarize: summarize what they say

Question 7

How can we use focusing open-ended skills to create a personal context?

Answer 7

ask about persona/psychosocial context of sx, beliefs

Question 8

Name the following emotion-seeking skills

• “How are you doing with this?”
• “How does this make you feel?”
• “How has this affected you emotionally?”

Answer 8

direct

Question 9

Name the following emotion-seeking skills

• “How has this affected your life?”
• “What has your knee pain been like for your family?”)

Answer 9

Indirect

Question 10

Name the following emotion-seeking skills

• “I think I might be frustrated if that happened to me.”

Answer 10

Self-disclosure;

Question 11

Name the following emotion-seeking skills

“What do you think might be causing your knee pain?”)

Answer 11

Beliefs about the problem;

Question 12

Name the following emotion-seeking skills

• “What made you decide to come in now for your…?”
• “What else is going on in your life?”

Answer 12

Triggers

Question 13

How should you respond to feelings/emotions?

Answer 13

NURS

• N: name the emotion “you say being fat makes you angry”
• U: understand “I understand”
• R: Respect “i know this is hard, you are brave”
• S: Support: “ I want to help you”

Question 14

how can we expand story?

Answer 14

1. continue to elicit more personal and emotional context
2. address feelings and emotions with NURS

Question 15

How do we transition to a clinician-centered interview?

Answer 15

1. Brief summary
2. Check accuracy
3. Tell them style of interview will change “im going to ask you qs about whats going on to help me understand”

Question 16

value of a 3rd party:

1. 25% of visits with older patients involves a third party care giver.
2. •Can provide a sense of security and comfort for the patient.
3. •A properly conducted interview involving a relative or other third person can often provide information otherwise unavailable.
4. •You can often use family or other parties to convince the patient to stay in the hospital or to undergo specific testing.
5. •They can help you understand limitations of the patient and what the patient’s baseline level of functioning is.
6. •They can often process information the patient may not hear or understand.
7. •They will most likely be caring for the patient when they go home.

Question 17

in step 1, how should you address other ppl in room?

Answer 17

1. introduce
2. ask pt if they can stay
3. tell them you value input, but youll ask info l8r
4. pt empathetic and attentive

Question 18

when should you ALWAYS insist on having alone time w patient

Answer 18

if pt is a W and person with her is a man

Question 19

when is best time to explore IPV and trafficking

Answer 19

when moving from interview => PE, ask person to wait outside while you od PE

Question 20

Always insist on a chaperone if performing any _________. This will protect you from allegations of inappropriate conduct.

Answer 20

sensitive exam

Question 21

For less responsive, very ill or dying patients, family will be extremely important to obtain critical information.

• Identify if the patient has an Advance Directive (AD), Living Will (LW), or a Power-of-Attorney (POA) to allow end of life decisions to be made by others.
• Once the patient’s needs have been addressed, consider your obligation to the relatives, who also need to feel heard and understood.

Question 22

Include family in all discussions involving care, evaluation and treatment only after_______

Answer 22

get permission from the patient.

Question 23

The Gillickcase in 1986 recognized that mature minors are owed a duty of confidentiality in respect of their medical information.

• Most states (Missouri included) have state consent laws that apply to all minors age 12 and older requesting; contraceptive services, STI services, Prenatal care, Adoption placement, medical care for their child, abortion services.
• Many states allow, but do not require a provider to inform a minor’s parents or guardian when the minor seeks services for reproductive care. It is often times left to the discretion of the physician.

Question 24

what is the age of consent to marry missouri w and wo parental consent

Answer 24

• 15YO to get married with parental consent (only 1 is needed)
• 18YO to get married w/o

Question 25

The “Show-Me” state allows

Answer 25

minors younger than 15 to get married “under special circumstances and for good cause.”

Question 26

• Any suspicion of child abuse or neglect identified by a health care provider must be reported to the Children’s Division/CPS (Child Protective Services) hotline => if not, lose medical liscence
• Once you are suspicious of child abuse or neglect notify security or law enforcement to be standing by. Be straight-forward with parent(s) or guardian that there are some concerns about child abuse or neglect and that you are reporting these concerns to Child Protective Services for them to investigate. At this point the child should be separated from the parent or suspected abuser in order to obtain separate interviews and to protect the patient.

Question 27

Domestic Violence and Child Abuse Protocol:

Answer 27

Step 1: Identify any signs of abuse, neglect or violence

• Step 2: Consult with a colleague and, if necessary, seek advice from the reporting center for domestic violence and child abuse, or discuss the case with a child abuse/neglect specialist.
• Step 3: Talk to the person(s) involved.

Question 28

Be aware of the sensitive nature of HIPPA and the disclosure of sensitive and confidential medical information with another person in the room.

Question 29

Your previously unrecognized responses affect your relationship with the patient and third parties

Once patterns are established, they remain throughout one’s career.

•Unrecognized thoughts, feelings and emotions have harmful potential and should be addressed.

Question 30

During the interview, observe how other parties interact with the patient.

• Determine if more or less information is being obtained in the presence of the third party.
• If a third party interrupts or answers all questions for the patient, or is in any way interfering, it is what should you do?.
• If the parties are not disruptive, you may find they can often provide insight and clarification of details the patient is unable to provide.

Answer 30

best to focus on them, obtain the information they can provide, and then respectfully excuse them from the room and thank them for their contribution

Question 31

Guidelines for the use of Interpreters

• Recognize the encounter will take at least twice as long.
• Use trained interpreters whenever possible.
• Ask for exact translation.
• Place interpreter out of the sight-line.

•Speak directly to the patient and watch his/her face when the interpreter is translating.

•Write down key points, instructions and ask interpreter to transcribe exactly word for word for the patient.

•Check for comprehension by asking patient to summarize their understanding to the interpreter.