FoPC 1 - Notes Flashcards
What are the 3 types of interviewing skills?
- Content skills
- Perceptual skills
- Process skills
What is meant by content skills?
What doctors communicate:
- The substance of their questions and responses
- The information they gather and give
- The treatments
What is meant by perceptual skills?
What they are thinking and feeling:
- Their internal decision making and clinical reasoning
- Their awareness of their own biases, attitudes and distractions
What is meant by process skills?
How the doctors do it:
- The ways doctors communicate with patients
- How they go about discovering the history or providing information
- The verbal and non-verbal skills they use
- The way they structure and organize communication.
What are the two broad types of factors affecting communication?
- Physical factors
2. Personal factors
What are the 4 physical factors which affect consultation?
- Site and Environment
- Adequacy of Medical Records
- Time constraints
- Patient status
What is mean by “Site and Environment” in a physical factor which will affect the consultation?
Attendance at a roadside accident vs doctor in an A&E
What is mean by “Adequacy of Medical Records” in a physical factor which will affect the consultation?
Adequate records of the history - to avoid wasting time in reviewing
What is mean by “patient status” in a physical factor which will affect the consultation?
New or Known patient
What are the personal factors which will affect the consultation?
- Age
- Sex
- Background and Origins
- Knowledge and Skills
- Beliefs
- The illness
How might “Age” affect the consultation?
Younger patients like younger doctors vs older patients like older doctors
How might “Sex” affect the consultation?
Generally, people prefer a doctor of the same sex
How might “Backgrounds and Origins” affect the consultation?
Social class, ethnic factors, and language difficulties will affect if you seek help
How might “Knowledge and Skills” affect the consultation?
Consider when a doctor is a patient, it will change the nature of the consultation
How might “Beliefs” affect the consultation?
Beliefs about diseases are influenced by the media, and are not medically accurate
How might “The Illness” affect the consultation?
Consultations of terminal illnesses are harder to conduct
What are the 3 types of doctor/patient relationship models?
- Authoritarian / Paternalistic relationship
- Guidance / Co-operation
- Mutual participation relationship
What is involved in a Authoritarian / Paternalistic relationship?
The physician uses all the authority inherent in his status and the patient feels no autonomy. He tries to please and does not actively participate in his own treatment
What is involved in a Guidance / Co-operation relationship?
The physician exercises authority, the patient is obedient, but has a greater feeling of autonomy and participates more actively in the relationship
What is involved in a Mutual participation relationship?
Most desirable for complex diagnostic interview, management of patients suffering chronic illness. Patient feels some responsibility which involves active participation and personal autonomy. Created by moderation of the doctor’s use of authority
What are the two types of interviews?
- Closed
2. Open
What is meant by a “Closed” interview?
An interview which is similar to a written questionnaire/ interrogation.
What is meant by a “Open” interview?
An interview where the doctor listens, facilitates and discusses the possible ways forward
What are the 3 activities which can be involved in a consultation?
- Talking together - always occurs
- Doctor examining the patient - occurs often
- Performing procedures - this is rarely done
What are interviewing techniques used to encourage communication?
- Open ended Questioning
- Listening and Silence
- Facilitation
- Confrontation
- Support and Reassurance
- Non-Verbal Communication
What are the different types of questions?
- Open-ended
- Direct
- Closed
- Leading
- Reflected
What is meant by an “Open-Ended” question?
A question which is not seeking any answer but simply signals to the patient to tell his story
What is meant by a “Direct” question?
A question which asks about a specific item
What is meant by a “Closed” question?
A question which can only be answered by a “yes” or “no”
What is meant by a “Leading” question?
A question which presumes the answer and is best avoided
What is meant by a “Reflected” question?
A question which allows doctor to avoid answering a direct question from patient
What is meant by “Facilitation”?
This is the act of encouraging communication by using manner, gesture or words that do not specify the kind of information that is sought
When might “Confrontation” be used?
When the patient is not speaking freely and clearly
How might “Confrontation” be used?
The interviewer describes to the patient something striking about his verbal or non-verbal behaviour
What is meant by “Support and Reassurance”?
The clinician’s ability to be appropriately supportive and reassuring helps create an atmosphere in which the patient is encouraged to communicate. It also helps to promote the continuity of the relationship
What is meant by non-verbal communication?
Body language
What is the percentage break-down of our verbal / tone / non-verbal communication?
Verbal - 7%
Tone of voice - 38%
Non-verbal - 55%
What are the 4 types of non-verbal communication?
- Instinctive (crying, expressing pain, laughing etc.)
- From training (courses)
- Clinical - doctors learn to recognize certain clinical syndromes from non-verbal messages
- Learned - prom past experienced (acquire body language from a young age)
What are the four points to consider when interpreting non-verbal communication?
- Culture (body language differs between cultures)
- Context (body language interpretation depends on context)
- Gesture clusters (single may be misinterpreted, multiple re-inforce the message)
- Congruence (when body and verbal language don’t match)
What are 3 body language gestures?
- Gaze behavior
- Posture
- Specific gestures
- Hand to face actions
What is meant by “Gaze behavior”? And why is it important?
Eye contact - it indicates interest, and can allow for the tell if someone is being honest and holding back information (looking away)
What information does “Posture” provide?
Information about the feelings of the patient (e.g. depressed, pain etc.)
What are included in “Specific gestures”?
Common barrier positions:
- Folded arms
- Legs / feet crossed
What are Hand to Face actions which indicate deceit?
- The mouth guard (the hand covers the mouth)
- The nose touch
- The eye rub
- The ear rub
- The neck scratch
What is the WHO definition of health?
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity
What is the difference of “Disease” and “Illness”?
Disease – physiological or psychological dysfunction
Illness – a person’s experience of “being ill”
What are the medical factors which affect the uptake of medical care?
- New symptoms
- Visible Symptoms
- Increasing severity
- Duration
What are the non-medical factors which affect the uptake of medical care?
- Family crisis
- Peer pressure
- Beliefs
- Expectations
- Economic / social class
- Psychological
- Environmental
- Cultural
- Ethnicity
- Age
- Gender
- The Media
What are the ethical issues implicated in treating a patient?
- Respecting Autonomy of individuals
- Do no harm to the patient
- Ensure that your expertise is justly distributed amongst all the patients under your care
What is the difference between “Empathy” and “Sympathy”?
Empathy - the ability to understand the predicament of another
Sympathy - that is feeling for them
