[comm] Flashcards
guide interview by redirecting the patient
redirecting
communicate and compare
clarify
fill in any gaps in info
summarizing
background through which HPI develops
general context of symptoms
the patient’s views strategies
active listening
open & closed questions
clarify
redirect
summarize
summay+general context
time of onset
quality home
severity
duration + frequency
topics to be discussed in order to reach an agreement
nature of problem
roles of doctor and patient
goals of treatment
four key elements of communication
clear info
questions from patient
readiness to discuss
agreement
clinician makes decisions on behalf of patient without including them
paternalistic model
the clinician makes decisions on behalf of patient based on what they know about patient’s preferences
professional as agent paradigm
clinician provides info and patient decides independently
informed consumer model
clinician and patient share info and discuss treatment plan
collaborative model
corner stone in reaching agreement
collaborative patient-clinician relationship
ASK to assess patients needs by asking about (6)
privacy
physical + emotional needs
knowledge + understanding
attitudes + motivation
informational needs
literacy
TELL components (6)
1-tell info briefly
2-personalize info
3-systematic approach
4-simple non alarming words
5-appreciate patient prior successes
6-advice patient w/ supplementary resources
ASK about patients understanding , emotions barriers (3)
check for:
1-patient’s understanding
2-emotional responses (respond accordingly)
3-barriers
systematic approach template
name problem
discuss what’s expected
discuss what’s to be done
common pitfalls in valuing the patient’s views (5)
1-narrowing focus prematurely thru closed-questions
2-controlling convo
3-restricting info
4-failing to clarify/reopen inquiry
5-failure to elicit
clarification is done thru
open & closed questions
drawing conclusions helps
decrease likelihood of late arising /hidden complaints
+
helps increase diagnostic accuracy
non verbal warmth & attentiveness is done thru (5)
1-eye contact
2-posture
3-tone
4-pace
5-attentive silence
greeting
explaining the situation
summarizing
stating: patient’s concerns are my 1ry focus
respond to emotions right away
encourage participation
….demonstrate
verbal warmth & attentiveness
outcomes of a positive doctor patient relationship (6)
1-trust
2-no hidden concerns
3-better diagnosis
4-better physical-emotional outcome
5-better coping
6-satisfaction
skills needed to build postivie relationship (4)
1-competent doctor
2-warmth, attentiveness, empathy
3-support+reassurance
4-partnership
a complex process that begins by identifying the nature of the problem, defining preferred roles and involvement in decision making, and agreeing on goals
reaching agreement
common pitfalls in reaching an agreement (6)
1-making prior assumtpions about patient’s preferences
2-failure to discuss all aspects of problem
3-failure to agree on goals of TTT
4-prescribing plans w/o reaching agreement
5-failure to re-evaluate goals over course of illness
6-intepreting patient’s failure to implement plans as non compliance instead of identifying barriers
leading and matching are ____behaviors
unconscious
first impressions are based on
nonverbal communication
nonverbal structure of empathy
positive connection with your patient
rapport
behavior that accurately reflects real,internal feeling of person
nonverbal
facial expressions
eye gaze
gestures
body position
kinesics
space b/w interacting individuals
proxemics
qualities of voice: tone, rate, rhythm, volume, emphasis
paralanguage
involuntary nonverbal signs that reflect person’s internal state & emotional statys
autonomic changes
general patterns of nonverbal response
safe
fight
flight
conversation-withdrawal
relaxed body, facial muscles
arms & legs uncrossed
body in open bosture
neutral facial color
safe pattern
increased body tension
leaning forward w clenched fists
narrowed eyebrows
flaring of nostrils
tensing of mouth
breath deepens
fight pattern
increased body tension + disengagement
person pulls back
head turned
avoiding eye contact
arms & legs crossed
faster, shallower breathing
flight pattern
relative immobility
sagging of face and limbs
voice is very soft
hesitant speech
neutral facial color
conversation-withdrawal
imitating patient’s behavior
helps build safety & trust
matching
synchronization achieved by matching process
leading
non-verbal connection that leads patient from feeling unsafe to safe
leading
non-verbal connection that shows your patient that you understand their emotions & relate to them
matching
reinforces feeling of power and control
vertical height difference
best angles of facing?
used when?
side-side
presenting lab reports/documents
best approach when dealing w cultural differences
patient centered approach
skills needed to deal w cultural differences
curiosity
empathy
respect
skills needed to deal w cultural differences
curiosity
empathy
respect
common pitfalls in dealing w cultural differences
1-too much details=uncomfortable, confusing conversation
2-patient’s response is frustrating
3-avoid attacking patient+control your emotions
crucial points in diagnosis of anxiety disorders
detailed history
respect & analysis of symptoms
anxiety should be suspected in
-pain, fatigue, neurological symptoms
-recent exacerbation of illness
-major life problems & stress
-showing nervousness (verbally/nonverbally)
-illnesses that lead to anxiety
anxiety disorders detected by
GAD-7
response to patient w/ anxiety
empathy
appreciation
interest
support
red flags in substance abuse
-physical findings
-mental symptoms
-social problems
-education& employment history
-legal problems
-family history
diagnostic criteria in drug abuse
DSM-IV-TR (12)
failure to fulfill obligations
use despite hazardous situations
use depsite problems caused by substance
legal problems
substance abuse
-tolerance
-withdrawal symptoms
-substances taken in larger amounts/longer periods of time
-excessive time spent on acquiring substance
-obligations unfulfilled
-substance use despite problems caused by substance
substance dependence
accurate diagnosis of substance abuse depends on
careful non biased interview
questionnaire used to assess substance abuse
CAGE
dealing w alcoholics requires
experienced knowledge
NIAA safe limits
MEN: 4 drinks/day
WOMEN: 3 drinks/day
best approach in dealing w alcoholics
patient-centered approach
if an alcoholic patient is uninterested
throw light on need for future quitting
if alcoholic patient is uncertain
motivate them
if an alcoholic patient is ready for change
augment their confidence
alarming signs of alcohol abuse
alcohol in breath
DUI
family history
steps of breaking bad news
1-getting started
2-what the patient already knows
3-how much do they need to know
4-sharing the info
5-responding to feeling
6-planning follow up
treatment plan of MUS (4)
antidepressant
2-substituting addicting medications
3-physical therapy
4-involving family member
