Class 1: History Module

Question 1

What is the content of an introduction. How do you ensure you elicit full spectrum of concerns?

Answer 1

1. student introduces self
2. student clarifies role/position
3. Student asks patient name
4. student asks chief concern
5. student clarifies agenda

To ensure that the full spectrum of concerns has been obtained, it’s important to find out if there’s anything else the patient wishes to discuss until the patient says, “No.”

Question 2

how does a inquiring physician obtain timeline of symptoms?

Answer 2

If several symptoms are reported, it is important that their chronological relationship to each other be determined. The interviewer need not gather the information in a chronological order or all at once, as long as the information needed is obtained during the interview.

Question 3

what purposes does summarizing data offer?

Question 4

what are the 2 components of transitional statements

Answer 4

what and why

Question 5

what characteristics need to be observed during interview?

Answer 5

patient’s comfort (environmental temperature and lighting, positioning, need for modesty
and privacy)

Question 6

what is the most valued skill of patient care

Answer 6

Relating effectively with patients is among the most valued skills of clinical care. For the patient, “a feeling of connectedness . . . of being deeply heard and understood . . . is the very heart of healing.”1

Question 7

patient-centered vs physican centered approach to interviewing?

Answer 7

Experts have defined patient-centered interviewing as “following the patient’s lead to understand their thoughts, ideas, concerns and requests, without adding additional information from the doctor’s perspective.”

in the more symptom-focused, clinician-centered approach, the cli- nician “takes charge of the interaction to meet her or his own need to acquire the symptoms, their details and other data that will help her or him identify a disease,” which can overlook the personal dimensions of the illness.

Question 8

what are the techniques of skilled interviewing

Answer 8

Transitions
Reassurance
Empowering the patient and emphatic responses
Partenring
Active listening
nonverbal communication
Guided questioning
Summarization and validation 

TREPANGS

Question 9

doctor’s non verbal language?

Answer 9

proxemics or closeness), gestures, facial expressions, and touch (or kinesics), and voice tone and rate of speech (or paralanguage)

Question 10

reflection

Answer 10

Reflection acknowledges a patient’s emotional state. Responses like “I can see that that upsets you” or “ you seem irritated” or “you seem down” proves your perceptive abilities and concern.

Question 11

legitimation

Answer 11

Legitimation communicates acceptance of and respect for the patient’s emotional experience. It lets patients know that their feelings are understandable and make sense. Comments like “I can understand why you’re angry” or “anyone would find this very difficult” or “your reaction is perfectly normal”

Question 12

respect is implied by

Answer 12

Respect is implied by attentive listening and nonverbal signals.

Question 13

2 major components of the medical interview

Answer 13

There are two major components of the medical interview which are evaluated: content and
process.

Content: What doctors communicate – the substance of their questions and responses, the information they gather and give, and the treatments they discuss.

Process: The second major component of the interview is how doctors communicate. Process refers to the technique, or style, that the interviewer uses in obtaining information from the patient.

Question 14

What happens when an individual first notices that (s)he’s not well?

Initial responses?

Answer 14

1. Do I know the cause or explanation?
2. Could this be a serious illness? Even a first sign of disability or death?
3. Can I do something to relieve the symptom(s)?

Initial responses frequently include:
1. Attempt at self-treatment (specific or non-specific, whether or not cause is identified)
2. Seeking help from non-medical source (parent or grandparent, spouse, folk healer (e.g.,
curandero) or internet source (“I looked up my symptom on Google…”)
3. Denial (can be conscious or unconscious; the latter is a classic defense mechanism that
reduces anxiety) or avoidance (“It will go away on its own” - which is frequently correct.) 4. Desire to tell story of illness (“You wouldn’t believe the pain I had…”)

Question 15

How is onset of serious illness often interpreted by patient and/or the family?

Answer 15

1. Threatened loss of control. Sometimes patients’ actions (refusal to follow treatment plan, questioning doctor’s recommendations) may be an attempt to maintain some control in a threatening situation. Cole also describes “threat of loss of body function” (e.g., urinary or fecal incontinence.)
2. Impending dependency. Patients who do not feel comfortable depending on others for care may feel the need to justify their dependency by excessive complaints about their care.
3. Dependency may arouse fears of closeness; patients uncomfortable with interpersonal closeness may say they prefer to be left alone.
4. Separation from home, friends and family, that adds to the pain of illness.
5. Threat of loss of love (Cole) “that illness will make them unattractive or unlovable.”
6. Failure to maintain personal health, and thus threatened self-esteem. (Threat to efficacy – Cole)
7. Fear of suffering and mortality. (Threat of pain – Cole)
8. Fear of mutilation (from disease or surgical treatment). (Threat of Loss of Body Parts – Cole)

Question 16

A 2001 study repeated a classic 1961 study by Kerr White that showed most symptoms experienced by an individual during any given month are

Answer 16

A 2001 study repeated a classic 1961 study by Kerr White that showed most symptoms experienced by an individual during any given month are self-limited or treated by self-care or someone in the home.

Question 17

iatrotropic stimulus

Answer 17

The answer to the question: “Why did you seek help today?” (vs. yesterday or tomorrow) is called the iatrotropic stimulus (that which moves the patient toward the physician); and often is a clue to understanding the patient’s perspective (his perception of cause (etiology) of the symptoms, or explanatory model).

Question 18

onset of illness is characterized by

Answer 18

• Search for meaning of the illness
• Stress of uncertainty about impact of symptoms
• Uncertainty about legitimacy of disease (“betwixt and between” health and illness)

Question 19

reaction to diagnosis is characterized by

Answer 19

Sometimes an anticipatory grief reaction to a shattering diagnosis
• Need to “make sense” of the illness
• Challenge to families to develop new communication patterns around the illness to avoid patient’s feeling abandoned
• Need to deal with possible guilt, anger, fear of vulnerability

Question 20

major therapeutic effors

Answer 20

Adjustment to new roles within the family, trade-offs between patient’s and family’s needs

Question 21

recovery

Answer 21

Children (or adults) may regress to earlier patterns of dependence
• Sometimes after peak of stress and danger is past, reactive depression ensues
• Need to negotiate privileges/responsibilities that have been relinquished (“secondary gain” from the illness, either patient or family members)

Question 22

outcome

Answer 22

When permanent disability is the outcome, need to adjust from role of “sick person” to living with a disability.
• Usually families establish a new equilibrium within 12 months of severe crisis
• Healthy coping characterized by ability to share the burdens associated with the illness with other
family members or resources outside of the family.