L1 Interview Process

Question 1

Common problems that PCPs demonstrated in interviews

Answer 1

Inattention to symptoms
a high control style
incomplete data base, omitted pt centered data
failed to formulate working hypothesis

Question 2

Patients are interrupted after…

Answer 2

18-23 seconds, sometimes 11 seconds
Patients need 32-90 seconds to disclose concern

Question 3

What does clear communication facilitate?

Answer 3

1. comprehension of pts complaint to arrive at an accurate dx, prognosis, poc
2. De-escalation of potentially disgruntled patients
3. Agreement upon what is being said (specifically medical terms)

Question 4

Patterns of Communication and Content Style

Answer 4

1. Patient questions, then physician gives info. Consumerist style, preferred by physicians
2. Psychosocial pattern, involves emotion, social context, feelings. Preferred by patients

Question 5

When physicians used reflective statements…

Answer 5

patients were more likely to perceive high autonomy support

Question 6

When physicians were empathic

Answer 6

patients were more likely to report high satisfaction

Question 7

Neutral or ineffective practices w/patients

Answer 7

closed ended questions
simple reflections
Inconsistent behaviors (advising w/out permission, confronting. etc)

Question 8

Effective mechanisms to enhance satisfaction and autonomy in patients

Answer 8

Empathy
Evocation
Collaboration
Autonomy
Open ended questions
Complex reflections
Consistent behaviors (asking permission, affirming, etc)

Question 9

Patients are highly satisfied with musculoskeletal PT care when these three things are met

Answer 9

1. Interpersonal aspects of care–> effective communication and empathy
2. Continuity of care and adequate tx duration
3. Well-organized care

Question 10

____ _____ was infrequently and inconsistently associated with patient satisfaction

Answer 10

Treatment outcome

Question 11

Empathy

Answer 11

more effective than reassurance, humor, or counseling in decreasing anxiety, building compliance, satisfaction

Question 12

Developing Empathy

Answer 12

the patient is not the disease
make sure to recognize the expression of emotions. Allow, Acknowledge, and offer

Question 13

Verbal vs Non verbal communication

Answer 13

1. non verbal signals are stronger, quicker, more direct than the effect of verbal signals
2. Non verbal is a subconscious reflex, so more genuine
3. Body language and facial expressions are continuous, vs communication is discontinuous

Question 14

How do you convey sincerity and concern?

Answer 14

direct eye contact
nodding of head in agreement
facing the patient

Question 15

Promoting Retention

Answer 15

1. Told first
2. Believe is important
3. Repeated to them

Provide important info first, stress the importance, use short words to be specific, repeat key points

Question 16

Hearing

Answer 16

attention to sounds and literal interpretation of their meaning

Question 17

Listening

Answer 17

grasping true meaning of what is being communicated through verbal and non-verbal cues

Question 18

Hindrances to listening

Answer 18

unwilling to listen
attending to only what they want ot hear
weandering thoughts
language differences resulting in perceptual differences
lack of experience in listening
egocentric bias

Question 19

Strategies to enhance interview process

Answer 19

Listening
Environment
Retention

Question 20

Environment strategies

Answer 20

people need privacy
minimal noise
low level of distractions
control frequency of interruptions
remain in clothing

Question 21

Patient Centered Interview

Answer 21

In the beginning:
1. Conduct a brief discussion of what will occur in session
2. Confirm that is what patient is expecting
3. Use ICF model

Question 22

Results of patient centered medicine

Answer 22

1. increased patient knowledge
2. more accurate risk perceptions
3. greater number of decisions consistent w/patients values
4. reduced level of internal decision conflict
5. less chance of patient remaining passive or undecided

Question 23

Traits of Expert Clinicians

Answer 23

listen well
educate patient
hands on
detect confusion
seek clarification

Question 24

Communication Challenges

Answer 24

Confusion
Hearing deficits
Anger
Depression

Question 25

Confusion

Answer 25

try asking 1 question at a time
restate/summarize what pt told you
avoid medical jargon
rephrase questions
change to close ended questions

Question 26

Hearing Deficits

Answer 26

lip reading–have good lighting, facing patient
sit 3-6 feet from patient
avoid covering mouth
avoid looking way
speak deliberately
hand written questions
pose questions to patient not translator

Question 27

Anger

Answer 27

Confirm the observations about their anger
stay calm and relaxed to defuse the situation

Question 28

Depression

Answer 28

may need to reprioritize questions
HEP may need reprioritization
can determine if there is imminent harm to patient

Question 29

History

Answer 29

provides info about disorder, who the patient is, and guides in formulating a working diagnosis

identify past medical history, and present illness

Question 30

Red flag S/S

Answer 30

finding that indicates that cause of the problem is not neuromusculoskeletalm and/or requires referral to other health care provider

one is not a cause for extreme concern, should raise concern

look for associated S/S

Question 31

Yellow flag S/s

Answer 31

may indicate a more severe problem
may require a more extensive eval
may increase level of precaution or tx
might be non-specificm could have variety of causes

Question 32

Cancer Red flags

Answer 32

persistent pain at night
constant pain anywhere in body
unexplained weight loss
loss of appetite
unusual lumps or growths
unwarranted fatigue

Question 33

Red flags Cardiovascular

Answer 33

SOB
dizziness
pain or heaviness in chest
pulsating pain
constant and severe pain in lower leg or arm
discolored or painful feet
swelling w/out injury

Question 34

Gastro/Genitourinary Red Flags

Answer 34

severe abdominal pain
frequent heartburn or indigestion
frequent nausea or vomiting
change in or problems w/ bowel or bladder
unusual menstrual irregularities

Question 35

Neurological Red Flags

Answer 35

changes in hearing
frequent or severe headaches w/no injury
problems w/swallowing or changes in speech
fainting spells
sudden weakness
changes in personality

Question 36

Miscellaneous Red Flags

Answer 36

fever or night sweats
severe emotional disturbance
swelling or redness in any joint

Question 37

Misc Yellow Flags

Answer 37

bilateral S/S
peripheralizing S/S
multiple nerve root involvement
abnormal sensation patterns
saddle anesthesia
abnormal s/s
vertigo
progressive weakness
progressive gait disturbances
multiple inflamed joints
psychosocial stresses
circulatory or skin changes
pregnancy

Question 38

History questions

Answer 38

1. MOI
2. Aggravating/relieving factors
3. 24 hour history
4. improving/static/worse
5. new/old injury
6. past history
7. diagnostic imaging

Question 39

How do you document a patients statement?

Answer 39

use their own words

Question 40

Systemic pain

Answer 40

disturbs sleep
deep aching or throbbing
reduced by pressure
constant waves of pain and spasm
is not aggravated by mechanical stress

Question 41

Musculoskeletal pain

Answer 41

generally lessens at night with rest
sharp or superficial ache
usually decreases w/stopping activity
continuous or intermittent
is aggravated by mechanical stress

Question 42

Nerve pain

Answer 42

sharp, bright, burning

Question 43

Bone pain

Answer 43

little radiation of pain

Question 44

Fracture pain

Answer 44

sharp, severe, intolerable

Question 45

Vascular pain

Answer 45

diffuse, aching, poorly localized

Question 46

Muscle pain

Answer 46

hard to localize, dull, aching. Pain on stretch and contraction

Question 47

Inert tissue pain

Answer 47

pain with stress or pinched