Clinician Centered Interviewing Skills Flashcards
Clinician Centered Interviewing Skills - Overview
I. Closed Ended Data Gathering Skills
II. Integrating Pt and Clinician Centered Skills
III. Sx Defining Skills - Sign v Sx, Identify Sx (ROS), Clarifying Sx, Seven Descriptors
Clinician Centered Interviewing Skills - Closed Ended Data Gathering skills
Yes/No/Brief Answers
Have yo noticed…, Have you ever felt…, How high was x… What Color was…
Clinician Centered Interviewing Skills - Integration of Patient Centered with Clinician Centered
Coning Down - Begin with Open-ended questions and follow up with closed ended questions.
“how is the health of” –> What type of X
Continue to be alert to the Pt’s emotional state to inclue verbal and nonverbal and bring it back to the emotion seeking/empathy skills.
Clinician Centered Interviewing Skills - Symptom Defining Skills S/S
Sx - Subjective and noticed by the person; N, h/a, Pain - obtained in the HPI
Sign - Objective and identified by the clinician; Murmur, perforated TM, Ascites - obtained in the PE
Clinician Centered Interviewing Skills - Symptom Defining Skills ROS
A non-exhaustive list of known Sx in layman’s terms.
Clinician Centered Interviewing Skills - Symptom Defining Clarify Sx
For example the Pt may state that they have a migraine, which is a Dx so you might associate this as a head ache and aim to clarify their Sx.
Or the Pt uses a non-medical term, or use something like dizziness, which you will need to clarify because these can mean different things (vertigo, etc)
Clinician Centered Interviewing Skills - Symptom Defining 7 Descriptors OPQQRST
Onset and chronology
Position and Radiation
Quality
Quantification
Related Sx
Transforming Factors
Clinician Centered Interviewing Skills - Symptom Defining 7 Descriptors Onset and Chronology
Onset - when did it start
Duration - how long did it last
Frequency - how often does it occur
Time course - has this bee a long or short term problem
Clinician Centered Interviewing Skills - Symptom Defining 7 Descriptors Position and Radiation
Can you describe where the pain is located, point to it, draw around the area?
Is it superficial or deep?
Does it radiate anywhere else?
Clinician Centered Interviewing Skills - Symptom Defining 7 Descriptors Quality
Ask the Pt to describe the Sx
Tearing chest pain could be aortic distention
Burning chest pain gastritis
Throbbing - migraine
Burning, electric, shooting - neurological
Cramping - d/o of a hollow organ
Clinician Centered Interviewing Skills - Symptom Defining 7 Descriptors Quantify
Severity scale (1-10 and type of pain)
Rate of onset - sudden or gradual
Identify associated impairments
Clinician Centered Interviewing Skills - Symptom Defining 7 Descriptors Related Sx
Have you noticed anything else that has gone along with this?
Clinician Centered Interviewing Skills - Symptom Defining 7 Descriptors Setting
Circumstances that sontribute to the Sx
Includes environmental/social factors, activity, or emotions
“what were you doing when you first noticed the pain”
Where were you when this happened, who else was present
How were you feeling when this happened?
Clinician Centered Interviewing Skills - Symptom Defining 7 Descriptors Transforming
Transforming Factors
What triggers or aggravates the Sx
What alleviates or relieves the Sx
Clinician Centered Interviewing Skills - OLDCART and ICE
Onset
Location
Duration
Characteristics
Aggravating Factors,
Relieving Factors
Treatment
Impact on ADLs
Coping Strategy
Emotional Response
Clinician Centered Steps - 6: Expand and Clarify
Id and clarify the Pt’s Sx
Clarify chronological description of HPI
OPQQRST
Inquire about other Sx not mentioned by the Patient - the pertinent positives
the absence of Sx - just as important = pertinent negatives
obtain non-symptom data - Hospitalization, labs, medical procedures, new medications.
Clinician Centered Steps - 6: Expand and Clarify HPI
Avoid leading
Avoid medical jargon
Ask things like: what do you think is causing this, what made you come in today, have you ever had this before?
If forget to ask something try to reach the patient to get that information.
Clinician Centered Steps - 7 PMH overveiw
Adult illnesses
Childhood Illnesses
Medications
Allergies
Health Maintenance
Clinician Centered Steps - 7 PMH: Adult ilnesses
Medical: DM, HTN, HCemia, stokes, cancer, asthma, STDs…
Surgical/Hospitalizations: Indications, dates, complications
OB/GYN
Psychiatric: Dx, Tx, Hospitalizations.
“Do you ever had any medical problems?”
Clinician Centered Steps - 7 PMH: Adult illnesses OB/GYN
OB:
#of preg; Complications?
of deliveries; Complications
Any spontaneous or induced abortions
GYN:
Menses: age of onset, cycle length, duration, menorrhagia/dysmenorrhea, date of LMP or age of menopause
Contraceptives
Sexual activity
Clinician Centered Steps - 7 PMH: Childhood Illnesses
Dz - Measles, mumps, rubella, whooping cough, chicken pox….
Immunizations
How was your health as a child?
Clinician Centered Steps - 7 PMH: Medications
Ask about name, dose, route, frequency.
OTC
Herbal Supplements
Alternatives recommended by other providers
Clinician Centered Steps - 7 PMH: Allergies
Include the specific reaction.
List food, insects, environmental factors.
Latex, etc
Clinician Centered Steps - 7 PMH: Health Maintenance
Depends on age and gender
Immunizations - both childhood and adult
Screening Tests - and when the last one was performed
Clinician Centered Steps - 8 Social Hx
Goal is to identify factors outside of PMH that may impact current health or healthcare goals and influence overall health.
Smoking
Occupation
Diet
Alcohol
Hobbies
Travel Hx
Illicit Drug Use
Marriage/Kids
Exercise
Safety
Spirituality/Religion
Clinician Centered Steps - 8 Social Hx Alcohol
Determine use and Risk health or otherwise.
Do you consume
How much
when was last drink
Clinician Centered Steps - 9 Family Hx
1st degree
Identify ages and health statuses or cause of death
inquire whether anyone in the fam has similar physical problems to the patient or if anyone at home has been ill laterly with the same concerns.
Pay particular attention to any conditions that arise that have a familial tendency such as SV, DM, Thyroid, Ca, osteroporosis, mental illness
Clinician Centered Steps - 10 ROS
Screening tool
Brief and rapid to see if there is anything that was missed and if yes then expand
Clinician Centered Steps - 11 End!
Orient Pt to End of interview, and ask for permission to begin discussion
invite the Pt to participate in shared decision making.
Explain prognosis/Dx
Explain testing/Tx options, and incorp Pt preferences
Summarize Decisions/provide written planse and instructions.
Acknowledge and support and say goodbye.
