Comms 3 (History) Flashcards
What is history taking?
A consultation skill involving focused information gathering and detective reasoning.
The majority of the diagnostic process happens in the history-taking.
Examinations and investigations are there to test our hypothesis.
What is clerking?
Clerking is an information gathering process that is relatively indiscriminate.
What are the key components of a classic medical clerking?
Presenting complaint History of presenting complaint Past Medical History Drug History including Allergies Family History Social History Review of systems
What do you need to achieve out of a patient consultation?
Discover why they are there - understand the patient AND the problem
Share understanding
Share decisions and responsibility
Make effective use of the encounter
What aspects make up the history?
Verbal Information
Verbal Cues
Non-verbal Information
Non-verbal cues
Why is giving the patient space to talk important?
Recognition of verbal and non-verbal cues
Finding out little pieces of information may make all the difference
Prevents dehumanization
Attempts to tackle confirmation bias
Patient’s social history may impact the way they present
What is system 1 and system 2?
System 1 is the brain’s fast automatic and intuitive response (much more influential).
System 2 is the mind’s slower more analytical approach.
Why are examinations important?
It can be therapeutic for the patient
A good way to test out clinical hypothesis - more likely to add information to that hypothesis than remove it
Not necessarily rule in/rule out
So can be diagnostic AND therapeutic
What are the advantages and disadvantages of investigations?
Can be diagnostic and therapeutic
Risk that we might start chasing numbers or basing out hypothesis on investigation rather than history taking
Frustrating for the patient who has normal test results but still feels unwell.
How do we effectively communicate the results from examinations and investigations?
Share understanding with the patient
Tailor our experiences to the patient’s understanding, values and beliefs.
Need to give information in a way which can be understood.
Avoid medical jargon.
How does shared understanding help improve the consultation?
Gives time to think and translate for the patient in front of us.
Allows us to get our thoughts in order.
Allows for a system 2 sense check.
Allows us to explore the emotional rather than just the factual.
Give some examples of ways you could check understanding with a patient?
Could you explain back to me your understanding of what we’ve discussed?
Do you understand how you need to take the medication?
How are you going to fit this into your life?
What are some important things to remember at the beginning of a consultation?
Start open, not closed
Smile, handshake, individual greeting
Experiment with opening lines
Listen to the patient (let them speak for a min or so)
Actively encourage their contribution
Watch your patient whilst they are talking - pick up the cues
Why is it important to let the patient simply talk?
Saves time - they know the reasons they have come to see you and these need to be communicated
Hypotheses can be made quickly and inaccurately
All energy is channeled towards that hypothesis (confirmation bias)
Allows for an opportunity to negotiate the use of time - to agree on what to deal with now and what can be left for another time.
How to maintain an open and encouraging atmosphere in a consultation?
Using phrases such as: Tell me about... What is it like? What are you worried about? I was wondering whether... Sometimes I find... Its occurred to me that... I've known cases where... I had a patient once... Go on Tell me more (Eye contact and nodding)
