Communication Challenges

Question 1

What are the 5 steps of patient center interviewing?

Answer 1

1: set the stage
2: elicit chief concern
3: begin interview
4: use focusing skills to learn symptoms, personal context, and emotional context
5: transition to clinician centered phase

Question 2

What happens in stage 1 of the interview? How long should it take?

Answer 2

30-60 sec
Welcome, use name and ask how to address, introduce self and identify role, ensure readiness/privacy, ensure comfort and remove barriers

Question 3

What happens in stage 2 of the interview? how long should it take?

Answer 3

1-2 min
1. Indicate time available.
2. Forecast what you would like to have happen in
the interview.
3. Obtain list of all issues the patient wants to
discuss; specific symptoms, requests,
expectations, understanding.
4. Summarize and finalize the agenda: negotiate
specifics if too many agenda items.

Question 4

What happens in stage 3 and how long should it take?

Answer 4

30-60 seconds

1. Start with an open-ended request/question.
2. Use non-focusing open-ended skills (attentive
   listening) .
3. Obtain additional data from nonverbal sources.

Question 5

What happens in stage 4 and how long should it take?

Answer 5

3-10 minutes

1. elicit symptom story
2. elicit personal context
3. elicit emotional context
4. respond to feelings and emotions (NURS)
5. expand the story

Question 6

What does NURS stand for?

Answer 6

name (name the emotion and what they say causes it), understand, respect, support

Question 7

What happens in stage 5? How long should it take?

Answer 7

30-60 seconds
1. Brief summary.
2. Check accuracy.
3. Indicate that both content and style of inquiry will change if the
patient is ready (“I’d like to switch gears now and ask you some
questions to better understand what might be going on.”
4. Continue with Middle of the Interview.

Question 8

How does stage 1 change when there is a third party in the room?

Answer 8

– Identify who the other persons in the room are and their relationship
to the patient.
– Determine if both the patient and the other parties want all parties
present.
– Sit close to the patient and have other parties move as needed to
prevent interference with your interview with the patient.
– Express to the parties that you value their input but inform them you
will interview the patient first and then ask for their input later.
– Demonstrate empathy and attentiveness to the patient and family.

Question 9

How should you handle a third party if they seem to be answering all the questions?

Answer 9

Focus on them, obtain the information they
can provide, and then respectfully excuse them from the room and thank
them for their contribution before continuing on with your patient. ALWAYS insist on time alone with the patient at some point

Question 10

When is a good time to excuse the third party from the room?

Answer 10

Transitioning from the interview to the physical exam is a good time to say to the party, “I must ask you to wait outside while I do the physical exam. I will invite you back in once we have completed the exam.” This will allow you to explore issues of IPV or trafficking.

Question 11

When is a time to insist a chaperone stays in the room?

Answer 11

if performing a sensitive exam

Question 12

What are some things to consider with family members of very ill/dying patients?

Answer 12

• Family will be extremely important to obtain critical information.
• Identify if the patient has an Advance Directive (AD), Living Will (LW), or a Power-of-Attorney (POA) to allow end of life decisions to be made by others.
• Once the patient’s needs have been addressed, consider your
obligation to the relatives, who also need to feel heard and
understood.
• Listen to their concerns and emotions, use empathy skills, answer questions, and help find solutions.

Question 13

In general, when should family be included in discussions involving care, evaluation, and treatment?

Answer 13

In all discussions, after getting permission from the patient!

If a family member begins arguing, redirect questioning or request they leave the room until the interview is complete

Question 14

What are the state consent laws for minors in Missouri?

Answer 14

For patients 12 and older, is often left to discretion of physician if disclosing to parents things like contraceptive services, STI services, prenatal care, adoption placement, and medical care for their child or abortion services (w parental consent)

Question 15

failure to report suspicion of child abuse or neglect can result in what?

Answer 15

loss of your license

Question 16

What should happen when you have suspicion of child abuse/neglect?

Answer 16

Once you are suspicious of child abuse or neglect notify security or law enforcement
to be standing by. Be straight-forward with parent(s) or guardian that there are some
concerns about child abuse or neglect and that you are reporting these concerns to
Child Protective Services for them to investigate. At this point the child should be
separated from the parent or suspected abuser in order to obtain separate interviews
and to protect the patient.

Question 17

What is the domestic violence and child abuse protocol?

Answer 17

Step 1: Identify any signs of abuse, neglect or violence
Step 2: Consult with a colleague and, if necessary, seek advice from the reporting center for domestic violence and child abuse, or discuss the case with a child abuse/neglect specialist.
Step 3: Talk to the person(s) involved.

Question 18

What does title II of HIPPA establish?

Answer 18

Standards for processing electronic healthcare transactions. Requires organizations to have secure electronic access to health data and maintain privacy regulations

Question 19

What are the problems health care providers can face in dependent patient relationships?

Answer 19

Attempting to meet endless needs of the patient can cause frustration and rejection/distancing from patient can occur and prevent obtaining accurate information

Question 20

What are problems physicians can face in obsessive compulsive patient relationships?

Answer 20

Can have a battle for control that will cause the patient to shut down.

Question 21

What is a histrionic patient like and what problems might you face in the interview?

Answer 21

Dramatic, teasing, inviting, flighty, and impulsive. Can become angry, depressed, and jealous if they are noticed as attractive and outstanding

Question 22

What are problems that you can face in an interview with a masochistic patient?

Answer 22

Will often reject advice that would improve their situation.
Avoid providing reassurance, suggestions for improvement, or promises of cures. want to acknowledge issues and use less hopeful response

Question 23

What are problems you might face when interviewing a narcissistic patient?

Answer 23

Attitude of superiority towards providers; looking for best provider and trying to one-up. respond to respect and concern

Question 24

What problems might you face when interviewing a paranoid patient?

Answer 24

Can be disruptive and time-consuming, making demands and threatening legal action. avoid closeness, but be friendly and courteous

Question 25

What problems might you face interviewing a schizoid patient?

Answer 25

Need to accept that patient is not social and don’t try to force closeness or demand relating to others. make sure to prevent patient from withdrawing, maintain interest that is quiet and reassuring

Question 26

What are the guidelines for use of interpreters (7)

Answer 26

Recognize the encounter will take at least twice as long.
• Use trained interpreters whenever possible.
• Ask for exact translation.
• Place interpreter out of the sight-line.
• Speak directly to the patient and watch his/her face when the interpreter is translating.
• Write down key points, instructions and ask interpreter to transcribe exactly word for word for the patient.
• Check for comprehension by asking patient to summarize their understanding to the interpreter.

Question 27

Durable power of attorney (DOPA)

Answer 27

authority to act for another person in either specific or all legal/financial matters. Legal document granted by a court

Question 28

Health care agent

Answer 28

an advanced directive names a specific individual that has legal authority to make health care decisions for specific patient

Question 29

Surrogate

Answer 29

Informal medical decision making for patient based on relationship and knowledge of patients wishes

Question 30

Guardian

Answer 30

Court appointment as medical guardian to specifically authorize you to make health care decisions for someone else- answerable to appointing court