Health History and Documentation Flashcards
What kinds of things should you do to prepare for an interview with a patient?
- Do your homework
- Dress professionally
- Environment
- Introduce yourself
- Ask them the reason for the visit
What are some interviewing mistakes?
- Not introducing yourself
- Close-ended questions
- non-empathetic questions/answers
- Not listening
- Not patient-friendly language
- Too authoritative
- Leading.suggestive questions
- Not following-up on vague answers
When starting the interview, what are important things to remember?
- Appropriate body language - eye contact!
- Open-ended questions/listening
- Direction/re-direction if off-topic
- Analyze patient. May have to scare them slightly to drive home importance of health, but not too much.
- Sensitivity/empathy
- Cultural sensitivity
- Negotiation when it comes to setting up plans
What are the differences between biomedical and behavioral models of care?
The biomedical model is provider-driven, and gives information in an authoritative fashion. It “saves’ the patient, and is focused on compliance with the set plan. Respect is expected.
In comparison, the behavior model is patient-driven, and information is exchanged rather than given. Behavior is negotiated, and the whole interaction is more of a two-way conversation. Resistance is seen as information about barriers rather than a bad thing. Respect is earned
What are the two major components of behavior change?
- The five stages of change
2. Motivational interviewing
What are the five stages of change?
- Pre-contemplation
- Contemplation
- Preparation
- Action
- Maintenance
Stages of contemplation: I want to change but …
Preparation
Stages of contemplation: I can’t change.
Pre-contemplation
Stages of contemplation: I’ve already been doing it.
Maintenance, risk of relapse
Stages of contemplation: There are good and bad things about change.
Contemplation.
Stages of contemplation: I’m already doing it.
Action
What is the readiness ruler?
It is a scale of 0-10 to assess the stage of contemplation for change for a patient.
What is the confidence ruler?
It is a tool used to measure the confidence level of a patient in their goals that have been set.
What kind of question should you ask a patient about their confidence? What does this accomplish?
What would it take to get you to go from a 4 to a 10 in confidence? It reveals possible barriers to goals.
What does motivational interviewing accomplish?
It is based upon asking permission, and discovers how ambivalent a person is about the issue. Supporting self-efficacy is important.
What is MI? What are the 4 components?
Motivational interviewing: REDS
- Roll with resistance
- Express empathy
- Discover discrepancy
- Support self-efficacy
When a patient is resistance, what is an appropriate response?
Change your method, clarify reason for resistance. Opt for understanding.
What are positive ways to express empathy to a patient?
Active listening, with good eye contact. Repeating back, nodding, understanding.
How can you develop discrepancy?
State pros and cons: What is the best or worst thing that could happen to you if you don’t change?
What does creating discrepancy do for the patient?
It helps develop goals for the patient, and supports motivating them.
What is something that you can do to support self-efficacy?
ASK the patient what they want. Elicit-Provide elicit. Point out positive thoughts, and use the confidence ruler.
Is reassurance a good tool to use in interviewing?
It is to a degree, you don’t want to say that everything will be alright when you cannot deliver that promise. Only promise what you can control.
What are some other tools to use in interviewing?
Validation, summarizing, echoing.
What can you say to a patient that is silent?
Ask them if a different topic would be better to talk about.
