Interviewing & Health History (Bates ch. 3) Flashcards
The primary goals of the patient interview are to ____ and to _____ __ ______ of the patient through a trusting and supportive relationship
The primary goals of the patient interview are to listen and to improve the wellbeing of the patient through a trusting and supportive relationship
High-quality patient-clinician communication has been shown to _______, _______, _______, ________, and ______
Improve patient outcomes, decrease symptoms, improve functional status, reduce litigation, and decrease errors
What is the most commonly performed clinical interviention?
The interview, which will occur thousands of times in a clinicians career
What is the foundation of a therapeutic alliance between patients and clinicians?
Trust
Skilled interviewing is both ___-centered and ____-centered
patient-centered and clinician-centered
What does the patient-centered interview focus on?
recognizing the importance of the patients’ expressions of personal concerns, feelings, and emotions
What does the patient-centered interview evoke?
the personal context of the patient’s symptoms and disease
Define the patient-centered interview
following the patient’s lead to understand their thoughts, ideas, concerns and requests without adding additional info from the clinician’s perspective
What does the clinician-centered interview focus on?
taking charge of the interaction to meet their own needs to acquire symptoms, details, and other data that will help in identifying a disease
Which is preferred, the patient-centered interview, clinician-centered interview, or an integration of both?
Integration of both
What does an integration of the patient and clinician-centered interview style lead to?
A more complete picture of the patient’s illness and the conveyance of respect, empathy, humility, and sensitivity
What does the interview process require attention to?
The patient’s feelings and behavioral cues
The health history format provides an important framework for organizing the patient’s story into various categories pertinent to the patient’s _____, ______, and _______
present, past, and family health
The interview process is rigid - true or false
False, it is fluid
The interview should be open-ended - true or false
True
Techniques involved in the interview to cue patients to tell their stories include _____, ______, _______, ______, ______, ______, and _______
active listening, guided questioning, nonverbal affirmation, empathetic responses, validation, reassurance, and partnering
The health history format focuses your attention on ….
the kind of information that is needed.
The health history format facilitates…
clinical reasoning
The health history format provides…
a standardized communication between other healthcare providers involved in a patient’s care
Which history gives the clinician an opportunity to see the patient as a person and better understand their outlook and background?
The Personal and Social History
The Review of Systems should not include clinician-centered closed-ended questions
False, yes and no questions should be limited to the Review of Systems
This kind of history is used for new patients in most settings
A Comprehensive Health History
What kind of interview/history is best for a patient seeking care for a specific concern like a cough?
A focused or problem-oriented history, which is more limited and tailored to that specific problem
What should the interview focus on for a patient seeking care for an ongoing or chronic problem?
The patient’s self-management, response to treatment, functional capacity, and quality of life
List the 10 skilled interviewing techniques
(at every great newspaper, very respectful people see their enemy)
- active listening
- empathetic responses
- guided questioning
- nonverbal communication
- validation
- reassurance
- partnering
- summarization
- transitions
- empowering the patient
(at every great newspaper, very respectful people see their enemy)
Define active listening
closely attending to what the patient is communicating, connecting to the patient’s emotional state, using verbal and nonverbal skills to encourage expansion from the patient
Active listening does not involve nonverbal cues - true or false
False, active listening involves attending to the patient’s verbal and nonverbal cues.
_____ has been described as the capacity to identify with the patient and feel the patient’s pain as your own and respond in a supportive manner
Empathy
To express empathy you must first ________, then __________
recognize the patient’s feelings, then actively move toward and elicit emotional content
For a response to be empathetic it must convey…
that you feel what the patient is feeling
______ _______ shows your sustained interest in the patient’s feelings and disclosures
Guided Questioning
List the 7 techniques of Guided Questioning
(four grad students make cake every evening)
- Moving from open-ended to focused questions
- Using questioning that elicits a graded response
- asking a series of questions one at a time
- offering multiple choices for answers
- clarifying what the patient means
- encouraging with continuers
- using echo
(four grad students make cake every evening)
What type of questioning is this?
“Tell me about your chest pain. (pause) where do you feel it? (pause) has it traveled? (pause)”
Moving from open-ended to focused questions
What type of questioning is this?
“How many steps can you climb before you get short of breath”
Questioning that elicits a graded response
What type of questioning is this?
“Do you have a history of tuberculosis? (pause) asthma? (pause) pleurisy? (pause)”
Asking a series of questions one at a time
What type of questioning is this?
“Which of the following best describes your pain: aching, sharp, dull, stabbing, burning?”
Offering multiple choices for answers
What type of questioning is this?
“Tell me exactly what you mean by the flu”
or
“When you said you were behaving just like your mother, what did you mean?”
Clarifying what the patient means
What type of questioning is this?
using nonverbal clues such as leaning in, gesturing, nodding your head, or saying “go on”, “mhm”
Encouraging with continuers
What type of questioning is this?
Patient: the pain began to spread.
PA: it spread?
Patient: yes and I felt like I was going to die.
PA: wow going to die?
Echoing
Being sensitive to nonverbal cues allows you to …
read the patient more effectively and send messages of your own
What should you pay attention to for nonverbal clues?
- Eye contact
- facial expression
- posture
- head position and movement
- distance
- placement of arms or legs
