History taking skills Flashcards
Concepts for approaching threatening topics
Normalising questions
Approach with expectation of the symptom to defuse guilt
Use symptom exaggeration to determine true frequency
Use familiar language
Stage of the interview to use open ended questions
Opening stage
Situations to avoid open ended questions
Over-talkative
Extremely poor historian
Purpose of repetition or restatement of what the patient has said during interviews
Allow the patient feel you are actively listening
Purposes of summation during an interview
Allows patient to check if they have said everything they have intended to
Allow you to give structure to the information gained so far
Interview technique that includes leaning forward, nodding, ‘uh-huh’, ‘go on…’
Facilitation
Interview techniques used without focussing on a particular answer
Non-directive techniques
Interview techniques used when seeking a particular answer
Directed techniques
Stage of the interview to use closed questions
Towards the end
Patients to avoid closed questions with
Highly suggestible patients
Interview technique where the patient is gently reoriented towards the question
Redirection
Interview technique used to move from one topic to another
Transition
Three types of transition in interviews
Smooth transition
Referred transition
Introduced transition
Type of transition where a cue is taken from something a patient has just said
Smooth transition
Type of transition where a cue is taken from something a patient said earlier in the interview
Referred transition
Type of transition where a totally new topic is started
Introduced transition
Purpose of limit setting in an interview
To use time effectively
Interview technique where you point out to the patient something you think they are not telling you, or not being honest about
Confrontation
Interview technique where you suggest an association or relationship the patient might not be aware of e.g. ‘you seem anxious when talking about your partner. Are there any relationship difficulties?’
Interpretation
Type of interview technique where you purposefully disclose something about your own life
Self-revelation
Purposes of using silence during an interview
Indicate disapproval or disinterest
Allow the patient to feel they do not need to spend every moment talking
Facilitate further information from the patient
Interview technique where you ask a question based on the assumption a patient exhibits a behaviour without them having told you this e.g. ‘what’s your usual drink’
Symptom expectation
Purpose of using symptom expectation in interviews
Reduce the guilt or embarrassment of admitting a behaviour
Interview technique where you purposefully guess too high a frequency of a behaviour in order to elicit the true frequency e.g. ‘how many do you smoke a day? Fifty or sixty?’
Symptom exaggeration
Purpose of reassurance in interview
Instil hope and avoid despair for the patient
Possible drawback to using reassurance in interview
Instilling false hope
Interview technique where certain topics are deliberately left for later
Postponement
Interview technique where you suggest a certain behaviour or feeling is common/normal to reduce a patient’s embarrassment
Validation/normalisation
Interview technique where you provide realistic praise to a patient to encourage good self-esteem
Positive reinforcement
Interview technique where you use affirmative statements towards a patient e.g. ‘you have been through a tough time’
Statement of respect
Interview technique where you encourage the patient to ask questions
Partnering
Poor interview technique where possible answers are contained in the question
Suggestive questions
Poor interview technique where you ask multiple questions within one
Compound questions
Issues with asking compound questions in interview
Confuses the patient
Leads to a vague response
Non-verbal interview behaviour such as yawning, checking your watch etc. that indicates a lack of attention or interest
Negative nonverbal gestures
Interview technique where a patient’s own words are used to negate their answers e.g. ‘you said you can’t form relationships but you’ve told me about how close you are with your cousin’
Setting traps
Advantages to open questions
More informative
Disadvantages to open questions
Not time efficient
Low precision - do not focus on particular symptoms
Low reproducibility at another date
Advantages to closed questions
Time efficient
Reproducible
Allows focus on precise symptoms
Disadvantages of closed questions
Low yield in amount of information gained
Behavioural observation method where every nth event is described in detail E.g. every fifth time the patient appears to be openly responding is recorded in depth
Event sampling
Behavioural observation method where observations are made after a certain amount of time e.g. every fifteen minutes
Time sampling
Behavioural observation method where an attempt is made to explain the function of a certain behaviour made by a patient
Functional analysis/ABC analysis
Sequence that is recorded in functional analysis/ABC analysis
Antecedent
Behaviour
Consequences
Population groups functional analysis/ABC analysis is used with
LD setting
Dementia care
Challenging behaviour services
Communication to have with an interpreter, if using
Explain the goals of the interview
Explain the structure and content of the interview
Explain the need for literal translation
Ask for feedback if something is hard to translate
Ask about the patient’s degree of openness
Offer to debrief the interpreter afterwards
Substance traditionally used in narcoanalysis
Amobarbitol
Types of conditions that improve with amobarbitol
Non-organic
Type of doctor-patient relationship where the doctor decides the treatment and the patient is expected to comply
Paternalistic
Type of doctor-patient relationship where the doctor provides information and the patient makes any decisions themselves
Informative
Type of doctor-patient relationship where the doctor knows the patient, and helps them make a decision i.e. there is shared decision making
Interpretive
Type of doctor-patient relationship where the doctor attempts to steer the patient in a certain direction but ultimately the patient makes decisions themselves
Deliberative
Repeating what the patient has said exactly how they have said it
Repetition
Repeating what the patient has said but rearranging the sentence
Restatement
Apparent deterioration in a patient’s symptoms after an observation of improvement by a healthcare professional
Negative therapeutic reaction
Process by which a patient unconsciously attempts to mirror past relationships within a therapeutic relationship
Transference resistance
Interview technique where you attempt to understand the feelings of the patient
Empathy
Type of question that starts with ‘how is…’
Qualitative question
