Interviewing and Health History Flashcards
what are two approaches to the interview process
- patient centered
- clinician centered
patient centered interviewing
following the patients lead to understand their thoughts, ideas, concerns, and requests without adding additional information from the doctors perspective
clinician centered interviewing
takes charge of the interaction to meet his or her own need to acquire the symptoms, their details and other data that will help her or him identify the disease
what are 10 important features of the interview process
- respect
- empathy
- humility
- sensitivity
- attentiveness
- efficiency
- factuality
- validation
- reassurance
- sense of partnership
ten fundementals of skilled interviewing
- active listenining
- empathic responses
- guided questioning
- nonverbal communication
- validation
- reassurance
- partnering
- summerization
- transitions
- empowering the patient
what are four qualities of an active listener
- closely attending to what the person says
- taking into consideration the patients emotional state
- using verbal and nonverbal skills to encourage the patient to expand on concerns
- understand the meaning of those concerns
six steps in communicating empathy
- recognize the emotional moment
- pause to question
- name the emotion you believe is present
- communicate your understanding of the emotion and validate is presence
- respect the patients efforts with the emotion
- offer support and partnership
what are four examples of empathic responses
- how do you feel about that
- this really seems to be troubling you, can you say more?
- that sounds upsetting
- you must be feeling sad
what are four outcomes of establishing an empathic connection
- reduce anxiety related to isolation and abandonment
- imporve adherence
- increase level of patient provider connection
- reduce PA frustration
what are 7 examples of guided questions
- moving from open ended to focused questions
- asking questions that require a scaled response
- asking a series of questions one at a time
- offering multiple choices
- asking for clarification
- encouraging with continuers
- using echoing
what is the goal of guided questioning
facilitate full communication, in the patients own words, without interruption
what are two advantages of using guided questioning
- show interest in the patients feelings
- can help avoid questions that lead or stifle the patients ideas
what are three examples of questions that call for a graded or scaled response
- what percentage has your rash improved
- how many stairs can you climb before getting short of breath
- do you lack the strength for any activities of daily living
what does “encouraging with continuers” mean
encouraging the patient to continue speaking through verbal (“yes go on”) or non-verbal encouragement (pausing)
echoing (example)
using the patients own words to elicit a more specific response
“i have chest pain”
“did the pain start in your chest?”
what two reasons are given 70% as a reason for filing medical litigation
provider communication and attitude
paralanguage
qualities of speech such as volume, pacing, tone
what are two reasons why summarization important
- it lets the patient know you were listening
- it gives you a chance to catch something you might have missed
when should transitions be used? (example)
when moving to a new and different part of the interview
“next, I will do a physical exam, so I will step out for a minute while you put on a gown”
what are five ways that a provider can empower the patient
- convey an interest in the person, not the problem
- reveal the limits of your knowledge
- elicit and validate emotional content
- follow the patients leads
- make your clinical reasoning transparent
what are the three phases of a patient interview
- preparation
- interview sequence
- cultural context
what are four reasons why is preparation important in the interview
- reviewing the clinical record
- setting goals
- reviewing my apperance and behavior
- adjusting the enviroment
what are the ten steps in the interview sequence
- greeting and rapport
- establishing an agenda
- inviting the patient story
- exploring the patient perspective
- idenifying and responding to emotional cues
- expanding and clarifying the patient story
- generating and testing diagnostic hypothesis
- sharing the treatment plan
- closing the interview
- self reflection
rapport
a feeling of relationship, trust, empathy
what are four ways to help build rapport
- greet the patient by name
- use formal titles
- explain your role as a provider
- acknowledge and greet family members
what are three positional considerations helpful when building rapport
- sit at eye level
- positioned several feet from the patient
- remove physical barriers like bed rails
what are some good ideas when establishing the agenda
- ask if there was anything special that brought them in
- identify all concerns early in the interview
- ask summative questions at the end to bring problems out of the woodwork
what is the disease/illness distinction model
the idea that “disease” is a way for the provider to organize symptoms to guide diagnosis, while “illness” evaluates how a disease affects a person life experience and emotional state
what is the FIFE pneumonic
- feelings about the illness
- ideas about what is causing the illness
- ways the problem is impairing function
- what the patients expectations are regarding their health and care
what are the seven attributes of a symptom
- location
- quality
- quantity/severity
- timing
- onset
- remitting/exacerbating factors
- associated manifestations
what is the FIFE pneumonic used for
to help ask questions to understand a patients perspective
what is an important consideration when generating differential diagnosis
to avoid making a snap decision about what the diagnosis is
what is the cone analogy used to describe
the process of describing a symptom with open ended questions first, then more specifc questions
what are the three steps in sharing the treatment plan
- introducing choices
- exploring the patient preferences
- moving to a decision
if a treatment plan requires change that a patient is resistant to, what are three methods motivate new behavior
- ask open ended questions about why a person might change
- listen to the patients experience
- provide information with their permission
why is self reflection imporant
it allows the interviewer to think critically about how they might improve
why is it necessary for an interviewer to put the patient interview into a cultural context
many cultures have unique beliefs about health and medicine that need to be respected
what are three dimensions of cultural humility
- self awarenes
- respectful communication
- collaborative partnerships
