Difficult Relationships Flashcards
Do all problematic relationships reflect a vulnerability of the clinician?
Yes
Is how we feel about the relationship up to us?
Yes
What 4 things can we do to lessen the vulnerability?
- Fix what you can
- Be tolerant
- Get the advice of a colleague
- Listen on
What should we try to determine about silent patients?
Source of the silence
What might silence be due to?
Poor language skills, embarrassment, mental illness, etc
Should we allow for a warm up convo if the patient is just shy?
Yes
What can excessive talking suggest?
Euphoria, confusion, or a smokescreen to cover up sensitive info
What should we do for talkative patients?
Use more focused, short-answer-inducing questions
What is anger a response to?
Loss or a threat of a loss
What should we allow in angry or hostile patients?
Ventilation, empathy, resolution discussion, and if appropriate, an apology
Should we fight back?
No, explain my side (try RAPSAND)
Does anxiety share its source with anger?
Yes
What 5 ways can anxiety present?
- Denial (breast cancer example)
- Obsessiveness (list maker)
- Arrogance (I thought this was a REAL ER?!)
- Suspicion
- Regression (can you help me pull up my covers?)
What 4 responses should we have to anxiety?
- Bring attention to the anxiety
- Pay attention to attributions
- Try to understand its source
- Suggest new ways of coping
Are inebriated patients reliable to make informed decisions?
No; err on the side of what we feel is reasonable treatment
Should we be very careful and perform more tests on inebriated patients?
Yes
When should we release an inebriated patient?
When they are sober and well
What should we allow for in a crying patient?
Ventilation and explanation
What can crying represent?
Sadness, anger
What must we do for a crying patient?
Determine if they are suicidal and act appropriately (go look at slide 10 for suicidal details)
What should we do if seductive behavior persists from patients?
Get a chaperone
What 2 ways can a history be confusing?
- Diffusely positive (pt has every complaint in the book)
2. Vague or bizarre
What should we consider in a diffusely positive history?
Somatization syndrome and guide the interview into a psychosocial assessment
What should we consider in a vague history?
Psychosis or neurologic disease
What 2 things should we do for patients with limited intelligence?
- Show interest in the pt while getting history from family
2. Avoid talking down to the pt
Are literacy problems present? What should we confirm?
Yes, could be hidden by patients; if they can read written instructions
What is the best resource if we do not have a competent interpreter for a language barrier patient?
AT&T language line
How do we deal with patient’s with hearing or vision problems?
Write for the deaf, speak for the blind, and ask the patient how you can best communicate with him or her
What 5 things do we do for hearing issues?
- Minimize background noise
- Have a well lit face
- Encourage hearing aid use if pt has it
- Use repetition, then rephrasing if pt can’t understand
- Do not slow down, shout, or over articulate your speech for lip readers
What do we do for people with eyesight issues?
Use auditory cues to understand others’ mood, style, friendliness, and other features
What do we NOT do for patient’s with eyesight issues?
Do not offer unwanted help
What 2 things should we do for dying patients?
- Relieve physical discomfort
2. Encourage talk of and respond to emotional and practical needs
What do patients often want if they are dying?
Empathic witnessing and do not wish to undergo therapy or “fixing”
Should we find out why patients won’t do what it takes to get better?
Yes, typically patient’s want to get better
What do we do when more than one person is present?
- Introduce ourselves to everyone in the room and learn who each personal is
- Interview as usual but monitor how third party is doing
If the third party is intervening, what do we do?
Focus on them and obtain the info they have but then respectfully excuse and thank them
Are men more controlling in some cultures?
Yes
Should we ask the third party to wait outside for the physical exam?
Yes
What do we do if we suspect domestic violence?
We have to ask, just do it safely
What do we do if the patient asks us for advice on personal problems?
Don’t answer directly but ask them what they feel the pros and cons are and in what direction they are leaning
Should we treat health professionals like any other patient?
Yes; don’t cut corners or go over the top
Define Culture
Ideas, beliefs, values, and assumptions about life, created by people and transmitted across generations
What are the steps for culturally diverse patient?
- Understand your own culture and its biases
- Learn about the cultures frequently encountered in your hospital or clinic
- It is impossible to know health beliefs and practices of everyone
What are we and what can we get irritated with?
“Time people” and “Event people”
What does American culture often place an emphasis on?
Individuality and self-actualization
What reliance can frustrate a physician?
A culture that values reliance on family over reliance on self
What can relying solely on lists do for culture?
Generalizing
What can we say/ask for culturally diverse patients?
- What did you hope to get from this visit?
- What would typically be done for you in a clinic in your country?
- Support incorporation of those practices and comment on others that may be less benign
What is the bottom line?
Give them what they want and what they need!!
