Communication Challenges LECT

Question 1

What is the 5 step patient centered interview technique?

Answer 1

1. Set the stage
2. Elicit chief concern
3. Begin interview
4. Used focusing skills to learn 3 things (symptom story, personal and emotional context)
5. Transition to middle of interview

Question 2

What does step 1“setting the stage for the interview” involve?

Answer 2

• Welcome patient
• Introduction
• Removes barriers to communication
• Provide comfortable enviornment

Question 3

What does step 2“elicit chief complaint and set agenda” involve?

Answer 3

• State time available
• Forecast of interview
• Obtain list of all issues pt. wants to discuss
• Summarize and finalize the agenda

Question 4

What does step 3“begin interview w/ non-focusing skills” ?

Answer 4

• Start with open-ended request/question
• Use non-focusing open ended skills
• Obtain additional data from nonverbal sources

Question 5

What three things are you attempting to learn in step 4 (focusing skills)?

Answer 5

Symptom story

Personal context

Emotional context

Question 6

What are 3 ways to use open-ended skills in a patient interview?

Answer 6

Echos (repeat the patient’s words)

Requests (…can you tell me more about that?)

Summaries

Question 7

What is the personal context?

Answer 7

Psychosocial context of symptoms

Patient beliefs/attributions

Question 8

What are 5 methods to use emotion-seeking skills?

Answer 8

Direct

Indirect

Beliefs about the problem

Self-disclosure

Triggers

Question 9

How do you respond to a patient’s feelings/emotions?

Answer 9

NURS

(i know, I was triggered too)

N: Name

U: Understand

R: Respect

S: Support

Question 10

Give examples of questions you’d ask with the

NURS mneumonic

Answer 10

N: Name: “You say being disabled by this knee pain makes you angry?

U: Understand: “I can understand your feeling this way”

R: Respect: “I can see this has been a very difficult time for you.”

S: Support: “I want to help you get to the bottom of this, let’s see what we can do”

Question 11

What is the best way to transition to the middle of the interview?

Answer 11

SUMMARIZE

Question 12

When there is a third party present, when should the physician consider asking them to leave?

Answer 12

• Performing a sensitive physical exam
• Exploring if abuse is present
• Allowing patient privacy
• Disruptive thrid party

Question 13

With your very ill/dying patients, what are some ESSENTIAL things to ask about?

Answer 13

Advance directive (AD)

Living will (LW)

Power of attorney (POA)

Question 14

When performing sensitive exams, what should you always do?

Answer 14

Ask for a chaperone

(This will protect you from allegations of inappropriate conduct)

Question 15

What is a durable power of attorney (DPOA)?

Answer 15

The authority to act for another person in specified or all legal or financial matters

Question 16

Failure to report ______________ can result in loss of your medical license

Answer 16

Failure to report suspicion of child abuse/neglect can result in loss of your medical license

Question 17

What are the three preliminary steps in domestic violence and child abuse protocol?

Answer 17

1. Identify signs of abuse, neglect or violence
2. Consult w/ colleague/the reporting center/child abuse specialist
3. Talk to the person(s) involved

Question 18

Describe a:

Dependent

personality

Answer 18

• Seeks unlimted self-interest, attention and care
• Demanding
• Helplessness and sense of entitlement

Question 19

Describe a:

Obsessive-compulsive

personality

Answer 19

• Need to maintain control
• Obsessively focus on selected details to avoid experiencing anxiety
• Can place demands on time

Question 20

Describe a:

Histrionic

personality

Answer 20

• Needs to merge emotionally with others
• Communication is through emotions
• Overly dramatic
• Can become angry, depressed and jealous if not noticed as attractive or outstanding

Question 21

Describe a:

Masochistic

personality

Answer 21

Self-defeating

• Sense of love and attention is derived only through suffering
• Frequently reject advice that would improve their situation

Question 22

Describe a:

Narcissistic

personality

Answer 22

• A need to overcome low self-esteem and lack of confidence by overcompensating with attempts to act suprior and exceptional
• They do not have close relationships
• Attitude of superiority

Question 23

Describe a:

Paranoid

personality

Answer 23

• Distrust others and project their unwanted impulses onto others
• Intense and rigid suspiciousness
• complain of mistreatment and neglect

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Question 24

Describe a:

Schizoid

personality

Answer 24

• Often feel uninvolved and remote, are unable to love or be loved
• Isolated, unsociable, out of touch, relate poorly to others
• Often overly sensitive, fragile and lacking in resilience

Question 25

In terms of time management, what do you need to remember when using an interpreter?

Answer 25

Encounters will take twice as long

Question 26

Advice from Dr. Stewart:

Answer 26

He said in lecture not to worry about memorizing everything in the slides. The notecards cover the most important topics that are “testable”; most of his test questions are mainly common sense based :)