History and Interviewing Flashcards
What are the goals of history an interviewing?
Lead pt to maximum wellness Discover info leading to diagnosis and management Provide information about diagnosis Share info with health care management Education and prevention
Privileged Communication
Protects physicians, APNs or dentists from disclosing information against a patient on trial
Pitfalls in taking Hx
not appreciating cultural differences judgmental making medical model the only paradigm bias and lack of personal awareness medical jargon failing to check for pt understanding
Patient Level Barriers
Lack of Assertiveness
Trust
Fund of Knowledge - Lack of understanding about dx
Provider Level Barriers
Lack of Cultural Competence
Stereotyping
Intersection of Patient and Provider Barriers
Ethical Context Respect and Flexibility
Autonomy Beneficence Utilitarinaism Nonmaleficience Fairness of Justice Deontological
Factors that Enhance Communication
Courtesy Comfort Connection Confirmation Confidentiality Patient Centered
Leading Questions
“Have you been taking your meds?”
Techniques to Enhance Communication
Facilitate - encourage to say more Reflect - Repeat back Clarify Empathize Confront - Address disturbing behavior Interpret - Repeat back
Communication Tensions
Curiosity about you Anxiety Silence Depression Crying Physical intimacy Seduction Anger Avoidance of full story Financial Considerations - Can they afford meds
Structure of Hx
Identifiers: name, date, time, age, gender, race, occupation, and referral source Chief Complaint History of present illness (HPI) Past medical history (PMH) Family history Personal and social history (SH) Review of Systems(ROS)
Building the History
Avoid medical jargon
Take notes sparingly
Avoid leading questions
Start with general concerns, then move to specific descriptions
Clarify responses (where, when, what, how, and why)
Verify and summarize
Goal of screening
Find out if a problem exists
CAGE Questionnaire
Cutting down
Annoyance by criticism
Guilty Feeling
Eye-opener
TACE Questionnaire
how many drinks does it TAKE to feel high?
ANNOYANCE by criticism
have you felt you ought to CUT down on drinking
do you take EYE-OPENER drinks in morning for hangovers
CRAFFT Questionnnaire
More so for adolescents
have you driven or ridden a CAR driven by someone under the influence?
do you ever take drugs to RELAX, feel better or fit in?
do you ever take drugs when you’re ALONE?
do you FORGET the things you did when using drugs?
do you have a FAMILY member or FRIEND tell you to cut down?
have you ever gotten into TROUBLE from using?
Three questions to detect partner violence
Have you been hit, kicked, punched or otherwise hurt by someone in the past year?
Do you feel safe in your current relationship?
Is there a partner from a previous relationship who is making you feel unsafe now?
HITS questionnaire
Hurt you physically?
Insult or talk down to you?
Threaten you with physical harm?
Scream or curse at you?
FICA Questionnaire
Faith - spiritual heritage? writings important to you?
Importance - beliefs influence how you handle stress?
Community - belong to a spiritual community?
Address - do religious beliefs affect health decisions?
Gender neutral questions
Tell me about your living situation
Are you sexually active? In what way?
Different types of health history
Brief
Complete Inventory
Interim (see pt 6mo.-1yr)
PE (physical examination)
OLD CARTS for HPI
Onset Location Duration Character - Stabbing or dull? Aggravating/associated factors Relieving factors Temporal factors - continuous in the morning? Severity
Chief Complaint
Note all significant complaints
What symptoms brought you here?
How long has problem been present?
Note age, gender, marital status, occupation and previous hospital admissions
