Bates Chapter 3 - Interviewing & Health Hx Flashcards
Skilled Interviewing
Both patient-centered and clinician-centered
- clinician must focus on pt to elicit the full story and be able to interpret key info about pt to reach assessment and plan for symptoms
Interview Process
more than a series of questions, requires a highly refined sensitivity to the pt’s feelings and behavioral cues and helps understand the pt’s story from all sides and is fluid
should be open-ended to encourage pt’s to open up and explain things
Health Hx Format
structured framework for organizing pt information in written or verbal form
- format focuses your attention on specific kinds of info you need to obtain to facilitate clinical information and help form a dx and plan of action
Skilled Interviewing Techniques
- active listening
- empathic responses
- guided questions
- nonverbal communication
- validation
- reassurance
- partnering
- summarization
- transitions
- empowering the pt
Active Listening
lies at the heart of the pt interview
- don’t allow yourself to drift into other thoughts
- pay attention to every part of hx pt is telling you
- don’t get caught up in dx
- show you are paying attention and hearing their complaints of symptoms
Empathic Responses
allows you to build pt rapport and promote healing for pt
- empathy has been described as the capacity to identify with the pt and feel the pt’s pain as your own
- to express empathy, you must first recognize the pt’s feelings, then actively move toward and elicit emotional content
- for response to be empathic, must show that you feel pain pt is feeling
Guided Questioning
always start open-ended and move into more focused questions as pt explains symptoms and pain
- try to avoid yes/no questions so that pt can explain situation
- ask questions that invoke graded responses: ex: how many steps can you climb before you get short of breath? vs do you get SOB w/climbing stairs?
- make sure to clarify things you do not understand in pt’s hx w/clarifying questions, shows you are listening and want to understand everything
- echoing can be used to get pt’s to explain more about symptoms as well
Nonverbal Communication
make sure to be aware of how you come off with your facial expressions, posture, gestures, etc.
- mirroring pt’s language (tone, voice, etc) can help build rapport as well
Validation
take time to validate the pt’s experience and how it affected them emotionally and physically
Reassurance
never reassure pt w/things like “it’s going to be all right.” instead, notice the pt’s feelings and recognize that they are okay and provide reassurance that you will do your best to get to the bottom of it
- best reassurance is after pt fully understands the problem at hand
Partnering
make clear to pt you are hear to provide the utmost care and build a relationship w/them even if in hospital setting
Summarization
helps you show pt you are listening and also clarify anything you might be missing or might need to know in addition to fully treat pt
Transitions
use transitions to let pt know what you are going to do next, why, and help pt understand the direction in which things are going
- helps pt feels less anxious and more comfortable w/you as their provider
Empower Patients
when you empower pts to ask questions, express their concerns, and probe your recommendations, they are most likely to adopt your advice, make lifestyle changes, or take medications as prescribed.
good techniques:
- evoke the pt’s perspective
- convey interest in the pt not just their problem
- follow the pt’s leads
- elicit and validate emotional content
- share info w/pt especially at transition points during visit
- make clinical reasoning transparent w/pt
- reveal limits of your knowledge, make yourself more like them
Sequence and Context of Interview
- Preparation
- Sequence
- Cultural Context
Preparation for Interview
should include:
- reviewing clinical records
- setting goals for interview
- reviewing your clinical behavior and appearance
- adjusting environment
Sequence of Interview
should include:
- greeting pt and establishing rapport
- establishing agenda for interview
- inviting the pt’s story
- exploring pt’s perspective
- identify and responding to pt’s emotional cues
- expanding and clarifying pt’s story
- generating and testing diagnostic hypotheses
- sharing treatment plan
- closing interview and visit
- take time for self-reflection
Cultural Context of Interview
demonstrating cultural humility throughout
Disease/Illness Distinction Model
helps elucidate the different yet complementary perspectives of the clinician and the patient
- Disease: the explanation that the clinician uses to organize symptoms that leads to a clinical diagnosis
- Illness: a construct that explains how the patient experiences the dise
ase, including its effects on relationships, function, and sense of well-being
*clinical interview needs to incorporate both of these views of reality. melding of these perspectives forms the basis for planning evaluation and treatment
FIFE
acronym for exploring the patient’s perspective
F: The patient’s FEELINGS, including fears or concerns about the problem
I: the patient’s IDEAS about the nature and cause of the problem
F: the effect of the problem on the pt’s life and FUNCTION
E: the pt’s EXPECTATIONS of the disease, of the clinician, or of health care, often based on prior personal or family experiences
Clues to Pt’s Perspective on Illness
- direct statement by pt of explanations, emotions, expectations or effects of illness
- expression of feelings about the illness without naming it
- attempts to explain or understand symptoms
- speech clues
- sharing a personal story
- behavioral clues indicative of unidentified concerns, disaatisfaction, or unmet needs such as reluctance to accept recommendations, seeking a second opinion, etc.
NURSE (acronym)
mnemonic for understanding emotional cues
N: name–“that sounds like a scary experience”
U: understand–“its understandable you feel that way”
R: respect–“you’ve done better than most people would do with this”
S: support–“I will continue to work on you with this”
E: explore–“how else are you feeling bout it
OLD CARTS
mnemonic for 7 attributes of a symptom
O: Onset
L: Location
D: Duration
C: Character
A: Aggravating/Alleviating Factors
R: Radiation
T: Timing
Seven Attributes of a Symptom
- Location: Where is it? Does it radiate?
- Quality: What is it like?
- Quantity/Severity: How bad is it?
- Timing: When did (does) it start? How long does it last? How often does it happen?
- Onset (setting in which symptom occurs): Include environmental factors, personal activities, emotional reactions, etc.
- Remitting or Exacerbating Factors: Is there anything that makes it better? Worse?
- Associated Manifestations: Have you noticed anything else that accompanies it?