Communication Challenges LECT Flashcards
What is the 5 step patient centered interview technique?
- Set the stage
- Elicit chief concern
- Begin interview
- Used focusing skills to learn 3 things (symptom story, personal and emotional context)
- Transition to middle of interview
What does step 1“setting the stage for the interview” involve?
- Welcome patient
- Introduction
- Removes barriers to communication
- Provide comfortable enviornment
What does step 2“elicit chief complaint and set agenda” involve?
- State time available
- Forecast of interview
- Obtain list of all issues pt. wants to discuss
- Summarize and finalize the agenda
What does step 3“begin interview w/ non-focusing skills” ?
- Start with open-ended request/question
- Use non-focusing open ended skills
- Obtain additional data from nonverbal sources
What three things are you attempting to learn in step 4 (focusing skills)?
Symptom story
Personal context
Emotional context
What are 3 ways to use open-ended skills in a patient interview?
Echos (repeat the patient’s words)
Requests (…can you tell me more about that?)
Summaries
What is the personal context?
Psychosocial context of symptoms
Patient beliefs/attributions
What are 5 methods to use emotion-seeking skills?
Direct
Indirect
Beliefs about the problem
Self-disclosure
Triggers
How do you respond to a patient’s feelings/emotions?
NURS
(i know, I was triggered too)
N: Name
U: Understand
R: Respect
S: Support
Give examples of questions you’d ask with the
NURS mneumonic
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”
What is the best way to transition to the middle of the interview?
SUMMARIZE
When there is a third party present, when should the physician consider asking them to leave?
- Performing a sensitive physical exam
- Exploring if abuse is present
- Allowing patient privacy
- Disruptive thrid party
With your very ill/dying patients, what are some ESSENTIAL things to ask about?
Advance directive (AD)
Living will (LW)
Power of attorney (POA)
When performing sensitive exams, what should you always do?
Ask for a chaperone
(This will protect you from allegations of inappropriate conduct)
What is a durable power of attorney (DPOA)?
The authority to act for another person in specified or all legal or financial matters
Failure to report ______________ can result in loss of your medical license
Failure to report suspicion of child abuse/neglect can result in loss of your medical license
What are the three preliminary steps in domestic violence and child abuse protocol?
- Identify signs of abuse, neglect or violence
- Consult w/ colleague/the reporting center/child abuse specialist
- Talk to the person(s) involved
Describe a:
Dependent
personality
- Seeks unlimted self-interest, attention and care
- Demanding
- Helplessness and sense of entitlement
Describe a:
Obsessive-compulsive
personality
- Need to maintain control
- Obsessively focus on selected details to avoid experiencing anxiety
- Can place demands on time
Describe a:
Histrionic
personality
- 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
Describe a:
Masochistic
personality
Self-defeating
- Sense of love and attention is derived only through suffering
- Frequently reject advice that would improve their situation
Describe a:
Narcissistic
personality
- 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
Describe a:
Paranoid
personality
- Distrust others and project their unwanted impulses onto others
- Intense and rigid suspiciousness
- complain of mistreatment and neglect
-
Describe a:
Schizoid
personality
- 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
In terms of time management, what do you need to remember when using an interpreter?
Encounters will take twice as long
Advice from Dr. Stewart:
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 :)
