Interviews Flashcards
What does neurological diagnosis comprise of?
Patient interview, neurological examination and special investigations
Why is it important to understand the entire neurological state of a patient?
Neuropsychological disorders always occur within the context of many other neurological symptoms so need to understand entire state to understand the disorder, plan treatment and understand the patient and their aims/concerns
What are objectives of neurological diagnosis?
Anatomical diagnosis (which part of the nervous system is affected?) and pathological diagnosis (which mechanism caused this damage?). Correct diagnoses are necessary to offer the correct rehabilitation
How can the quality of an assessment be maximised?
Ensure patient feels relaxed. Explain all assessment measures thoroughly and the reason for them. Talk to patient, not family, but do not talk down to them and avoid jargon. Make sure patient knows they can take regular breaks and extend the assessment over multiple sessions if needed due to fatigue/concentration (which can make first test seem less impaired than it is and last test seem more impaired than it is)
What communication specific skills are needed to conduct an interview?
Introduce self (who you are, why you’re there), explain procedures (what you’re doing and why), and ask patient if they have understood. Paraphrase their answers to check your own understanding. Speech characteristics such as tone, pitch and pauses are important, as well as non-verbal cues such as facial, eye-movements, posture, gestures and personal space
What are the different types of personal space?
Intimate space, personal space, social space, public space. This can be difficult for patients to understand if they have frontal lobe lesions
What is a problem with the definition of a patient interview?
No single definition. Many different versions that vary in specificity
What is Murphy and Dillon’s 2008 definition of a patient interview?
A conversation characterised by respect and mutuality, by immediacy and warm presence, by emphasis on strengths and potential. Because clinical interviewing is in essence relational, it requires ongoing attention to how things are said and done as well as to what is said and done. The emphasis on the relationship is at the hear of the ‘different kind of talking’
What factors do good clinical interviews include?
Positive/respectful relationship, collaboration, active listening
What is the aim of clinical interviews?
Obtain information that will guide the clinical examination and use of special investigations. Information can guide the clinical examination and trigger an aetiological hypothesis which might be tested using special investigations
In what order do clinical interviews typically run?
Introductions, chief complain/presenting problem, history of present illness (detailed chronological description of all symptoms, prior care and possible risk factors), past medical history and family history to identify risk factors, social and environmental history (occupation, family situation, travel, habits etc), medications and allergies, summarise/questions/close (conclude main points covered and explain next steps)
What other functions can also be assessed during an interview?
Speech (articulation and content), mental status and alertness, eye movement/facial expressions, posture, emotions, mood
What is a possible problem of patient interviews?
They are subjective. Difficult in cases of anosognosia (patient lacks awareness of deficit) and anosodiaphoria (indifference to deficit so will report it on direct questioning but not spontaneously)
What is good about clinical interviews?
Provide the first stage of diagnosis by indicating potential impairments and their possible cause, and can then guide further investigations and neuroexam
