Ch. 1: Patient Interview Flashcards
Major items found on a patient history form
- Biographic data (age, gender, occupation)
- Chief complaint (OLDCART)
- Present health or history of present illness
- Past health,
- childhood illnesses, accidents or injuries, serious or chronic illnesses, hospitalizations, operations, obstetric history, immunizations, last examination date, allergies, current medications, and history of smoking or other habits
- Family history
- Review of each body system
- skin, head, eyes, ears, and nose, mouth and throat, respiratory system, cardiovascular system, gastrointestinal system, urinary system, genital system, and endocrine system
- Functional assessment (activities of daily living),
- activity and exercise, work performance, sleep and rest, nutrition, interpersonal relationships, and coping and stress management strategies
Primary tasks performed during the patient interview
1. Gathers complete and accurate data about the patient’s impressions about his or her health, including a description and chronology of any symptoms
2. Establishes rapport and trust so the patient feels accepted and comfortable in sharing all relevant information
3. Develops and shows an understanding about the patient’s health. This enhances the patient’s participation in identifying problems
What internal factors does the practitioner bring to the interview?
Internal Factors:
- a genuine concern for others, empathy, understanding, and the ability to listen.
- A genuine liking of other people is essential in developing a strong rapport with the patient.
- And optimistic view of people
- a positive view of their strengths, and an acceptance of their weaknesses.
- This affection generates an atmosphere of warmth and caring.
- The patient must feel accepted unconditionally.
- Active listening
- Note patient’s body language, tone of voice, breathing
Describe the cultural, religious, and spiritual issues in the patient interview.
Cultural awareness: involves the knowledge of the patient’s history and ancestry and an understanding of the patient’s beliefs, artistic expressions, diets, celebrations, and rituals.
Cultural sensitivity: refers to refraining from using offensive language, respecting accepted and expected ways in which to communicate, and not speaking disrespectfully of a person’s cultural beliefs.
Cultural competence refers to knowing the health-care practitioner’s own values, attitudes, beliefs, and prejudices while, at the same time, keeping an open mind and trying to view the world through the perspective of culturally diverse groups of people.
All health-care practitioners should continue to learn all they can about other cultures.
When in doubt, the health-care practitioners should simply ask the patient’s preferences, rather than trying to guess or stereotyping the patient based on previous experiences with other cultures.
Differentiate between open-ended questions and closed or direct questions.
Open-Ended:
- unbiased
- allows the patient freedom to answer in any way
- encourages the patient to respond at greater length and give a spontaneous account of the condition
- used for narrative
- elicits feeling, options and ideas
Closed or Direct Questions:
- asks patient for specific information
- yes, no, forced choise
- used to obtain specific data
- speed up the interview
- useful in emergency situation
Describe the nine types of verbal responses.
(The first 5, the patient leads. The last 4, the practitioner leads.)
Facilitation: encourages patients to say more, to continue with the story. Ex: “Mm hmm,” “Go on,” “Continue,” “Uh-huh.”
Silence communicates that the patient has time to think and organize what he or she wishes to say without interruption by the examiner. Good to use after an open-ended question
Reflection is used to echo the patient’s words. The examiner repeats a part of what the patient has just said to clarify or stimulate further communication. The examiner acts as a mirror reflecting patient’s words and feelings.
Empathy is defined as the identification of oneself with another and the resulting capacity to feel or experience sensations, emotions, or thoughts similar to those being experienced by another person.
It does not deny the patient’s feelings nor does it suggest that the patient’s feelings are unjustified.
Clarification is used when the patient’s choice of words is ambiguous or confusing: “Tell me what you mean by bad air.” Clarification is also used to summarize and simplify the patient’s words.
Confrontation: the examiner notes a certain action, feeling, or statement made by the patient and focuses the patient’s attention on it: “You said it doesn’t hurt when you cough, but when you cough you grimace.”
Interpretation links events and data, makes associations, and implies causes. It provides the basis for inference or conclusion: “It seems that every time you have a serious asthma attack, you have had some kind of stress in your life.” The examiner runs the risk of making an incorrect inference.
Explanation provides the patient with factual and objective information: “It is very common for your heart rate to increase a bit after a bronchodilator treatment.”
Summary is the final overview of the examiner’s understanding of the patient’s statements. It condenses the facts and presents an outline of the way the examiner perceives the patient’s respiratory status. It is a type of validation in that the patient can agree or disagree with the examiner’s summary.
Describe the nonproductive verbal messages that should be avoided during the patient interview.
Things to AVOID:
Providing assurance or reassurance gives the examiner the false sense of having provided comfort.
Giving Advice: know when to give advice and when to refrain from it. Respond directly, and the answer should be based on knowledge and experience. Refrain from dispensing advice that is based on a hunch or feeling. A patient who is an active player in the decision-making process is more likely to learn and modify behavior.
Using Authority The examiner should avoid responses that promote dependency and inferiority: “Now, your doctor and therapist know best.”
Using Avoidance Language When talking about potentially frightening topics, people often use euphemisms (e.g., “passed on” rather than “died”) to avoid reality or hide their true feelings.
Distancing is the use of impersonal conversation that places space between a frightening topic and the speaker. The use of frank, specific terms usually helps defuse anxiety rather than causing it.
Professional Jargon: What a health-care worker calls a myocardial infarction, a patient calls a heart attack. The use of professional jargon can sound exclusionary and paternalistic to the patient.
Asking Leading or Biased Questions: Asking a patient “You don’t smoke anymore, do you?” implies that one answer is better than another.
Talking Too Much: As a general rule, the examiner should listen more than talk.
Interrupting and Anticipating: Examiners who are overly preoccupied with their role as interviewer are not really listening to the patient. As a general rule, the examiner should allow a second or so of silence between the patient’s statement and the next question.
Using “Why” Questions: The examiner should be careful in presenting “why” questions. The use of “why” questions often implies blame; it puts the patient on the defensive.
List the positive and negative nonverbal messages associated with the patient interview.
Physical Appearance
Posture
Gestures
Facial Expression
Eye Contact
Voice
Touch
Describe how to close the interview
This final moment may destroy any rapport gained during the interview. To ease into the closing, the examiner might ask the patient one of the following questions:
- “Is there anything else that you would like to talk about?”
- “Do you have any questions that you would like to ask me?”
- “Are there any other problems that we have not discussed?”
