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ICM Exam 2 > Difficult Relationships > Flashcards

Difficult Relationships Flashcards

1
Q

Do all problematic relationships reflect a vulnerability of the clinician?

A

Yes

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2
Q

Is how we feel about the relationship up to us?

A

Yes

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3
Q

What 4 things can we do to lessen the vulnerability?

A
  1. Fix what you can
  2. Be tolerant
  3. Get the advice of a colleague
  4. Listen on
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4
Q

What should we try to determine about silent patients?

A

Source of the silence

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5
Q

What might silence be due to?

A

Poor language skills, embarrassment, mental illness, etc

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6
Q

Should we allow for a warm up convo if the patient is just shy?

A

Yes

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7
Q

What can excessive talking suggest?

A

Euphoria, confusion, or a smokescreen to cover up sensitive info

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8
Q

What should we do for talkative patients?

A

Use more focused, short-answer-inducing questions

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9
Q

What is anger a response to?

A

Loss or a threat of a loss

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10
Q

What should we allow in angry or hostile patients?

A

Ventilation, empathy, resolution discussion, and if appropriate, an apology

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11
Q

Should we fight back?

A

No, explain my side (try RAPSAND)

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12
Q

Does anxiety share its source with anger?

A

Yes

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13
Q

What 5 ways can anxiety present?

A
  1. Denial (breast cancer example)
  2. Obsessiveness (list maker)
  3. Arrogance (I thought this was a REAL ER?!)
  4. Suspicion
  5. Regression (can you help me pull up my covers?)
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14
Q

What 4 responses should we have to anxiety?

A
  1. Bring attention to the anxiety
  2. Pay attention to attributions
  3. Try to understand its source
  4. Suggest new ways of coping
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15
Q

Are inebriated patients reliable to make informed decisions?

A

No; err on the side of what we feel is reasonable treatment

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16
Q

Should we be very careful and perform more tests on inebriated patients?

A

Yes

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17
Q

When should we release an inebriated patient?

A

When they are sober and well

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18
Q

What should we allow for in a crying patient?

A

Ventilation and explanation

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19
Q

What can crying represent?

A

Sadness, anger

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20
Q

What must we do for a crying patient?

A

Determine if they are suicidal and act appropriately (go look at slide 10 for suicidal details)

21
Q

What should we do if seductive behavior persists from patients?

A

Get a chaperone

22
Q

What 2 ways can a history be confusing?

A
  1. Diffusely positive (pt has every complaint in the book)

2. Vague or bizarre

23
Q

What should we consider in a diffusely positive history?

A

Somatization syndrome and guide the interview into a psychosocial assessment

24
Q

What should we consider in a vague history?

A

Psychosis or neurologic disease

25
Q

What 2 things should we do for patients with limited intelligence?

A
  1. Show interest in the pt while getting history from family

2. Avoid talking down to the pt

26
Q

Are literacy problems present? What should we confirm?

A

Yes, could be hidden by patients; if they can read written instructions

27
Q

What is the best resource if we do not have a competent interpreter for a language barrier patient?

A

AT&T language line

28
Q

How do we deal with patient’s with hearing or vision problems?

A

Write for the deaf, speak for the blind, and ask the patient how you can best communicate with him or her

29
Q

What 5 things do we do for hearing issues?

A
  1. Minimize background noise
  2. Have a well lit face
  3. Encourage hearing aid use if pt has it
  4. Use repetition, then rephrasing if pt can’t understand
  5. Do not slow down, shout, or over articulate your speech for lip readers
30
Q

What do we do for people with eyesight issues?

A

Use auditory cues to understand others’ mood, style, friendliness, and other features

31
Q

What do we NOT do for patient’s with eyesight issues?

A

Do not offer unwanted help

32
Q

What 2 things should we do for dying patients?

A
  1. Relieve physical discomfort

2. Encourage talk of and respond to emotional and practical needs

33
Q

What do patients often want if they are dying?

A

Empathic witnessing and do not wish to undergo therapy or “fixing”

34
Q

Should we find out why patients won’t do what it takes to get better?

A

Yes, typically patient’s want to get better

35
Q

What do we do when more than one person is present?

A
  1. Introduce ourselves to everyone in the room and learn who each personal is
  2. Interview as usual but monitor how third party is doing
36
Q

If the third party is intervening, what do we do?

A

Focus on them and obtain the info they have but then respectfully excuse and thank them

37
Q

Are men more controlling in some cultures?

A

Yes

38
Q

Should we ask the third party to wait outside for the physical exam?

A

Yes

39
Q

What do we do if we suspect domestic violence?

A

We have to ask, just do it safely

40
Q

What do we do if the patient asks us for advice on personal problems?

A

Don’t answer directly but ask them what they feel the pros and cons are and in what direction they are leaning

41
Q

Should we treat health professionals like any other patient?

A

Yes; don’t cut corners or go over the top

42
Q

Define Culture

A

Ideas, beliefs, values, and assumptions about life, created by people and transmitted across generations

43
Q

What are the steps for culturally diverse patient?

A
  1. Understand your own culture and its biases
  2. Learn about the cultures frequently encountered in your hospital or clinic
  3. It is impossible to know health beliefs and practices of everyone
44
Q

What are we and what can we get irritated with?

A

“Time people” and “Event people”

45
Q

What does American culture often place an emphasis on?

A

Individuality and self-actualization

46
Q

What reliance can frustrate a physician?

A

A culture that values reliance on family over reliance on self

47
Q

What can relying solely on lists do for culture?

A

Generalizing

48
Q

What can we say/ask for culturally diverse patients?

A
  1. What did you hope to get from this visit?
  2. What would typically be done for you in a clinic in your country?
  3. Support incorporation of those practices and comment on others that may be less benign
49
Q

What is the bottom line?

A

Give them what they want and what they need!!

ICM Exam 2 (10 decks)

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