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Clinical Assessment II > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Definition of a difficult patient

A

The one with whom the physician has trouble forming an effective working relationship

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2
Q

How will you know if you are dealing with a difficult patient?

A

Difficult patient evoke a feeling of anxiety, pressure, boredom or frustration

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3
Q

Situational issues of a difficult incounter

A

language and literacy issues
multiple people in exam room
breaking bad news
environmental issues

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4
Q

Physician characteristics of a difficult encounter

A

angry or defensive
fatigued or harried
dogmatic or arrogant
tired (end of a long day)

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5
Q

Patient characteristics of a difficult encounter

A 
angry
defensive
frightened
resistant
manipulative
somatizing
grieving
"Frequent flyers"
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6
Q

2 steps to help with difficult pt

A

reframe your thinking

incorporate coping strategies

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7
Q

qualities of a successful physician-patient encounter

A

collaboration
appropriate use of power
empathy

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8
Q

Coping strategies to improve encouters

A

Collaboration
Appropriate use of power
Empathy

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9
Q

Strategies of Collaboration

A

Set priorities
Do thorough exams
Be consistent, honest, fair and clear with decision making
Coach pt to small achievable goals and symptom relief
Enlist the help of a team that includes pt families and other healthcare providers to improve quality

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10
Q

Strategies of appropriate use of power

A

Set clinical management rules which include limits and priorities to visits (num. and length)

Good Documentation

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11
Q

Strategies of empathy

A

Be compassionate, but firm
Be pt centered
Reinforce positives
Keep a professional distance
Understand psyche and emotions
Recognize and deal with your true feelings
Be alert for countertransference reaction in yourself
Involve colleague in your management plan
Improve yourself

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12
Q

important factors to remember with the care of all pts

A

Listening to the pt

Clarifying the pt’s concerns

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13
Q

What is key in any pt visit?

A

Listening

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14
Q

Behaviors of challening pts

A 
Silence
Confusion
Altered mental capacity 
Talkative
Crying
Angry / Disruptive
Demanding
Language barrier
Low Literacy
Complaining
Poor adherence
Needy
Drug-seeking
Seductive
Person Problems
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15
Q

Disabilities that make a pt visit challenging

A

Impaired hearing
Impaired vision
Limited intelligence

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16
Q

Tips for working with the silent pt

A

Silence is ok
Watch for nonverbal clues
Depression or dementia
Silence may be the answer

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17
Q

Characteristics of a confusing pt

A

They have everything wrong with them
Completely positive ROS
Hx is vague, difficult to understand, ideas are poorly connected and language is hard to follow
Difficult to get clear answers

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18
Q

Tip for working with the confusing pts

A

Focus on the meaning or function of the symptom
Emphasize the pt’s perspective
If you suspect psych or neuro d/o then use the MMSE

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19
Q

Definition of decision making capacity

A

Ability to understand information related to health, to make medical choices based on reason and a consistent set of values, and to declare preferences about tx

20
Q

To have decision making capacity, pts must be able to

A

Understand relevant information about proposed dx test or tx
Appreciate their situation
Use reason to make decisions
Communicate their choice

21
Q

Tips for visit with a pt with altered cognition

A

Obtain a consent before talking about their health with others - HIPAA
When conflicting info comes from a spouse, child or caregiver, may need to divide the interview into 2 parts

22
Q

Tips for visits with pts who have impaired capcity

A

Find a surrogate informant or decision maker, such as a DPOA for health care or a health care proxy
Apply basic principles of interviewing to your conversations with pt’s relatives or friends

23
Q

Characteristics of the talkative pt

A

Hard to get the whole story

24
Q

Tips for working with the talkative pt

A

Give pt free time for about 5 min and listen closely
Focus on what seems important to the pt
Interrupt only if necessary
Learn how to set limits
Summarize
Don’t show your impatience, simply suggest the importance of scheduling another appt

25
Q

Tips for visiting with the crying pt

A

Crying signal strong emotions
Most people who cry are able to compose themselves and move on, unless crying b/c of acute grief or loss
Crying makes people uncomfortable (pts and providers)

26
Q

If pt is on the verge of tears

A

Pause
Respond with empathy
Offer tissue
Give pt permission to cry

27
Q

Pt factors of anger

A

Pt illness
Grief
Loss of control
Feel powerless

28
Q

Provider factors of anger

A 
Late
Inconsiderate
Insensitive
Angry
Unresponsive
Cost of visits
29
Q

Tip for visiting with the angry or disruptive pt

A

Avoid joining in on hostility toward another provider, clinic or hospital
Validate their feelings w/o agreeing with their reasons

30
Q

Needs of the angry pt

A 
Empathy
Legitimization
Non-judgmental attitude
Respect of pt autonomy
Support
Flexibility
31
Q

7 steps for satisfying angry pts

A
  1. Handle problem privately
  2. Listen to pt’s complaints
  3. Disarm anger with kindness
  4. Delegate up when necessary
  5. Follow through on promises
  6. Involve the pt in prevention
  7. Be grateful
32
Q

If angry pt is overtly disruptive

A 
Alert Security
Stay calm
Appear accepting 
Avoid being confrontational
Listen
Try to understand what pt is saying 
Suggest moving to a more private area
33
Q

Characteristics of the demanding pt

A

Call frequently

Often come with an agenda or list of wants

34
Q

Tips for visits with the demanding pt

A 
Frequent, short visits
Negotiate agenda and goals
Set limits
Reinforcement
Compromise
Be flexible
Acknowledge his/her feelings
Avoid Arguments
Explain you rationale
Firm boundaries may be necessary for some
35
Q

Characteristics of a good interpreter

A

ideally neutral person familiar with both languages

36
Q

Characteristics of a poor interpreter

A

Family members
Friends
Untrained

37
Q

Why should you not sure a pt’s family member or friend as an interpreter?

A

Confidentiality violated
Meanings distorted
Transmit information incompletely
May try to speed up the interview

38
Q

Important aspects to remind the interpreter of

A

Explain that every word must be interpreted, not condensed or summarized

39
Q

Tips for a visit with pt who needs an interpreter

A

Review information most helpful to you

Make your questions clear, short and simple

40
Q

Guidelines for working with an interpreter

A

Choose trained interpreter
Use the interpreter as a resource for cultural information
Orient the interpreter to the components you plan to cover in the interview
Remind interpreter to translate everything the pt says
Arrange the room so that you and the pt have eye contact and can read each other’s nonverbal cues
Seat the interpreter next to the pt
Allow interpreter and pt to establish repport
Address the pt directly
Keep sentences short and simple
Verify mutual understanding
Be patient

41
Q

Acronym INTERPRET

A 
Introduction
Note goal
Transparency
Ethics
Respect beliefs
Patient focus
Retain control 
Explain
Thank everyone for their time
42
Q

Do not confuse degree of literacy with

A

Level of intelligence

43
Q

Tips for pts with low literacy levels

A

Ask how comfortable they are filling out medical forms

Have pt read written instructions back to you and ask them if they understand what is written

44
Q

Low health literacy leads to

A

poor health outcomes

45
Q

What are 3 ways to improve health literacy

A

Analogies
Simple Language
Ask Questions

46
Q

What is health literacy?

A

The degree to which an individual has the capacity to obtain, communicate, process and understand basic health information and services to make appropriate health decisions

Clinical Assessment II (1 decks)

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