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Clinical Skills > Communication > Flashcards

Communication Flashcards

1
Q

Clinical Skills

How should one enter the exam room and begin the medical interview?

1. ______ before entering

2. Introduce self by ______ and position

3. Use patient’s ______

A

1. Knock before entering

2. Introduce self by name and position

3. Use patient’s name

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2
Q

Clinical Skills

In general, how should you interact with the patient during the medical interview?

A

1. Sit and maintain eye contact

2. Ask open-ended questions

3. Listen actively

4. Focus on patient perspective/needs

5. Be warm and empathetic and non-judgmental

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3
Q

Clinical Skills

Give an example of the type of question you can use to begin the medical interview.

A

So, what brings you here today?

(open-ended; allows the patient to form her own thoughts in an organic manner)

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4
Q

Clinical Skills

How should you address the patient?

A

As Mr. _________, Mrs. _________, or Ms. _________ (surname)

(or as requested)

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5
Q

Clinical Skills

Why should physicians not be afraid of silence?

A

It allows space for the patient to form their thoughts and fill in relevant, additional information.

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6
Q

Clinical Skills

Before performing any physical exam, what should you do?

A

1. Explain what you will be doing.

2. Give a simple explanation as to the reason for the exam.

3. Ask permission to proceed

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7
Q

Clinical Skills

Outline the FIFE method of eliciting the patient’s perspective in regards to their illness.

A

Feelings

Ideas

Function

Expectations

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8
Q

Clinical Skills

What should be done to ensure the patient feels heard and that the physician has an accurate picture of the patient’s perspective and understanding?

A

1. Reflect and echo statements

2. Clarify

3. Summarize periodically

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9
Q

Clinical Skills

Outline the NURSE method of eliciting the patient’s emotional response to their illness.

A

Name the emotion

Understand the emotion

Respect the patient

Support the patient

Explore the emotion

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10
Q

Clinical Skills

How can you encourage your patient to ask questions and bring up additional concerns?

A

Explicitly tell them to from the beginning of the interview.

Allow space for silence and reflection.

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11
Q

Clinical Skills

What should you do at the end of the clinical interview (or at other moments like the end of the HPI)?

A

Summarize the main data points.

Re-outline the plan.

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12
Q

Clinical Skills

True/False.

At the end of the medical interview, you should ask, ‘do you have any questions?’

A

Clinical Skills

False.

At the end of the medical interview, you should ask, ‘what else would you like to know that we haven’t discussed?’

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13
Q

Clinical Skills

Name an excellent way to improve your differential diagnosis and also see what the patient understands of their S/Sy.

A

Ask: ‘what do you think is causing your symptoms?’

(or, if a diagnosis is already established, ask: ‘what do you know about your condition?’)

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14
Q

Clinical Skills

What should you do to check for patient understanding at the end of the patient interview?

A

Something along the lines of: ‘Let’s review. I try to be thorough and make sure I didn’t miss any important information; so, it helps me if you can tell me what you plan to do about/for your ________ (condition) when you leave here.’

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15
Q

Clinical Skills

What is an important step before encouraging a patient to change some pattern of behavior?

A

Assess their readiness to change

(pre-contemplation,

contemplation,

preparation,

action,

maintenance,

relapse)

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16
Q

Clinical Skills

What are the first three stages of change?

A

Pre-contemplation

Contemplation

Preparation

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17
Q

​Clinical Skills

What are the second three stages of change?

A

Action

Maintenance

Relapse (and recommitment)

18
Q

​Clinical Skills

How should you approach a patient who is a smoker and is in the pre-contemplation stage of smoking cessation?

A

Briefly stress importance of quitting

Leave the door open for future efforts (I.e. don’t alienate the patient)

19
Q

​Clinical Skills

How should you approach a patient who is a smoker and is in the pre-contemplation stage of smoking cessation?

A

Discuss their ambivalence

Discuss pros and cons

Validate

Stress that the decision is theirs to make

20
Q

​Clinical Skills

How should you approach a patient who is a smoker and is in the preparation stage of smoking cessation?

A

Identify social support

Identify and discuss barriers

Encourage small initial steps

Validate

21
Q

​Clinical Skills

How should you approach a patient who is a smoker and is in the action stage of smoking cessation?

A

Check-in

Bolster self-efficacy

Check for barriers

22
Q

​Clinical Skills

How should you approach a patient who is a smoker and is in the maintenance stage of smoking cessation?

A

Reinforce internal rewards

Discuss coping with relapse

23
Q

​Clinical Skills

How should you approach a patient who is a smoker and is in the relapse stage of smoking cessation?

A

Evaluate trigger for relapse

Reassess motivation and barriers

Plan stronger coping strategies

24
Q

​Clinical Skills

What is the most important determinant of a patient’s success in quitting smoking?

A

The patient’s desire to quit

25
Q

​Clinical Skills

Advice to quit smoking that is given by a physician has a ___% success rate.

A

Advice to quit smoking that is given by a physician has a 10% success rate.

26
Q

Clinical Skills

True/False.

Even small amounts of weight loss or exercise have significant health benefits.

A

True.

(Even if non-consecutive!)

27
Q

Clinical Skills

The methodology for breaking bad news follows the ________ protocol.

A

The methodology for breaking bad news follows the SPIKES protocol.

28
Q

Clinical Skills

Name the S in the SPIKES protocol for breaking bad news.

A

Set-up

  • (1. Arrange for privacy*
    1. Involve significant others*
    1. Sit down*
    1. Make connection with patient*
    1. Manage time constraints and interruptions)*
29
Q

Clinical Skills

Name the P in the SPIKES protocol for breaking bad news.

A

Assess Patient’s Perception

  • (1. Use open-ended questions*
    1. Correct misinformation*
    1. Determine if patient is in denial, wishful thinking, or unrealistic expectations)*
30
Q

Clinical Skills

Name the I in the SPIKES protocol for breaking bad news.

A

Obtain the patient’s invitation

  • (1. Get the patient to express their desire for information (to lessen the anxiety of delivering bad news)*
    1. Discuss information disclosure ahead of time (e.g. when the test is ordered) — ‘How would you like the information to be communicated?’)*
31
Q

Clinical Skills

Name the K in the SPIKES protocol for breaking bad news.

A

Give knowledge and information to patient

  • (1. Warn the patient that bad news is coming*
    1. Give medical facts (avoid jargon, euphemisms, and excessive bluntness)*
    1. Offer hope and treatment (even if just palliative) no matter how poor the prognosis)*
32
Q

Clinical Skills

Name the E in the SPIKES protocol for breaking bad news.

A

Address the patient’s Emotional response with empathy

  • (1. Observe emotional response; ask open-ended questions to illicit the emotion (if necessary)*
    1. Name the emotion*
    1. Provide empathetic responses (e.g. ‘I know this isn’t what you wanted to hear’)*
    1. Give space and time; show support)*
33
Q

Clinical Skills

Name the second S in the SPIKES protocol for breaking bad news.

A

Strategy and Summary

  • (1. Ask if the patient is prepared to discuss treatment*
    1. Present treatment options*
    1. Share responsibility for decision-making with patient*
    1. Check patient understanding*
    1. Understand patient goals*
    1. Frame hope in terms of possibility)*
34
Q

Clinical Skills

Outline the SPIKES protocol for breaking bad news.

A

Set-up

Assess patient perception

Obtain the patient’s invitation

Communicate knowledge and information

Address the patient’s emotional response

Strategy and summary

35
Q

Clinical Skills

Describe the S in the SPIKES protocol for breaking bad news.

Set-up

A

Set-up

  1. Arrange for privacy
  2. Involve significant others
  3. Sit down
  4. Make connection with patient
  5. Manage time constraints and interruptions
36
Q

Clinical Skills

Describe the P in the SPIKES protocol for breaking bad news.

Assess Patient’s Perception

A

Assess Patient’s Perception

  1. Use open-ended questions
  2. Correct misinformation
  3. Determine if patient is in denial, wishful thinking, or unrealistic expectations
37
Q

Clinical Skills

Describe the I in the SPIKES protocol for breaking bad news.

_Obtain the patient’s invitation_

A

Obtain the patient’s invitation

  1. Get the patient to express their desire for information (to lessen the anxiety of delivering bad news)
  2. Discuss information disclosure ahead of time (e.g. when the test is ordered) — ‘How would you like the information to be communicated?’
38
Q

Clinical Skills

Describe the K in the SPIKES protocol for breaking bad news.

Give knowledge and information to patient

A

Give knowledge and information to patient

  1. Warn the patient that bad news is coming
  2. Give medical facts (avoid jargon, euphemisms, and excessive bluntness)
  3. Offer hope and treatment (even if just palliative) no matter how poor the prognosis
39
Q

Clinical Skills

Describe the E in the SPIKES protocol for breaking bad news.

Address the patient’s Emotional response with empathy

A

Address the patient’s Emotional response with empathy

  1. Observe emotional response; ask open-ended questions to illicit the emotion (if necessary)
  2. Name the emotion
  3. Provide empathetic responses (e.g. ‘I know this isn’t what you wanted to hear’)
  4. Give space and time; show support
40
Q

Clinical Skills

Describe the second S in the SPIKES protocol for breaking bad news.

Strategy and Summary

A

Strategy and Summary

  1. Ask if the patient is prepared to discuss treatment
  2. Present treatment options
  3. Share responsibility for decision-making with patient
  4. Check patient understanding
  5. Understand patient goals
  6. Frame hope in terms of possibility

Clinical Skills (14 decks)

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