DocCom Module 9 Flashcards
In one video, Dr. Lown opens the discussion of Ms. Jones’ blood pressure by asking, “What do you think about your blood pressure today? The clinical assistant told me it was up.” Which of the following is the most important reason Dr. Lown chose this opening?
To discover how the patient views her blood pressure problem.
In Video 2, Dr. Lown talks to Ms. Allen about the impact that her asthma diagnosis has had on her life. What is Dr. Lown’s primary purpose in talking about this with the patient?
To communicate to the patient that she is interested in her as a person
Mrs. Muldoon, a 60-year-old Welsh woman with multiple medical problems comes to your office. She is on 7 chronic medications. As usual, her blood pressure is above target at 164/92. Since more than 50% of patients with chronic diseases do not take their medication as prescribed, you suspect that Ms. Muldoon is not taking all her medications. Which comment is the recommended initial strategy to address this issue?
“Mrs. M, most patients would find it difficult to take so many pills. How is it going for you?”
You are seeing 8 year old Darren, whom you know well, for asthma. Darren has been to the Emergency Room several times for asthma in the last few months. On exam you note wheezes, and wonder whether he is not regularly getting his medication because his family cannot afford the medication. Beginning with, “I know that you want Darren to be healthy….,” which is the recommended beginning to address this issue?
“…Medications for asthma are very expensive. Is paying for them an issue for you?”
A patient whose primary language is Spanish comes in complaining of headaches. The patient speaks some English and you have been taking a medical Spanish course. What is the best way for you to communicate with the patient?
Use a professional interpreter - for example with the clinic over-the-telephone interpretation service.
You are seeing a 23-year-old woman three months post-partum. You are pleased to learn that she is breast-feeding her baby successfully. She hasn’t resumed menstruating yet. You ask how she is doing with the oral contraceptive pills prescribed at the six-weeks-postpartum visit. The patient tells you she never filled the prescription. You decide to begin with, “So, you are not taking the pill right now…” what is the best way to conclude this comment?
“…Tell me what your thoughts or concerns are about taking the pill.”
Mr. F, a 65-year-old man comes to the Emergency room with a gangrenous foot. He has a history of poorly controlled diabetes and has missed some follow up appointments. He is seen by the surgeon on-call who determines that the foot cannot be saved and needs to be amputated. The surgeon presents this plan to the patient who responds, “I’m not going to be a guinea pig! You are not going to cut off my foot!” What would be the surgeon’s best initial response to Mr. F’s outburst?
“Tell me how you would like me to approach this problem with your foot.”
When you ask Mr. O’Brien, a 37 year old married auto mechanic whose wife and 6 children you also care for, about his use of alcohol, he says that he drinks 2 six-packs on weekends, and goes on to say, “Alcohol is not a problem for me. I can hold my liquor.” You know that this level of alcohol consumption is above national guidelines for safe use of alcohol. You see that he is not inclined to talk more about alcohol (patients who say, “not a problem” usually mean, “subject closed”), and you know that any comment from you may elicit a defensive response. Nonetheless you wish to continue. You begin your next comment with a simple reflection: “You do not see your drinking as a problem…” Which of the following responses is the least judgmental way to complete your turn in the conversation?
“…What would an alcohol problem look like to you?”
*If you actually read that question, you have earned your grade. :)
