L1 Interview Process Flashcards
Common problems that PCPs demonstrated in interviews
Inattention to symptoms
a high control style
incomplete data base, omitted pt centered data
failed to formulate working hypothesis
Patients are interrupted after…
18-23 seconds, sometimes 11 seconds
Patients need 32-90 seconds to disclose concern
What does clear communication facilitate?
- comprehension of pts complaint to arrive at an accurate dx, prognosis, poc
- De-escalation of potentially disgruntled patients
- Agreement upon what is being said (specifically medical terms)
Patterns of Communication and Content Style
- Patient questions, then physician gives info. Consumerist style, preferred by physicians
- Psychosocial pattern, involves emotion, social context, feelings. Preferred by patients
When physicians used reflective statements…
patients were more likely to perceive high autonomy support
When physicians were empathic
patients were more likely to report high satisfaction
Neutral or ineffective practices w/patients
closed ended questions
simple reflections
Inconsistent behaviors (advising w/out permission, confronting. etc)
Effective mechanisms to enhance satisfaction and autonomy in patients
Empathy
Evocation
Collaboration
Autonomy
Open ended questions
Complex reflections
Consistent behaviors (asking permission, affirming, etc)
Patients are highly satisfied with musculoskeletal PT care when these three things are met
- Interpersonal aspects of care–> effective communication and empathy
- Continuity of care and adequate tx duration
- Well-organized care
____ _____ was infrequently and inconsistently associated with patient satisfaction
Treatment outcome
Empathy
more effective than reassurance, humor, or counseling in decreasing anxiety, building compliance, satisfaction
Developing Empathy
the patient is not the disease
make sure to recognize the expression of emotions. Allow, Acknowledge, and offer
Verbal vs Non verbal communication
- non verbal signals are stronger, quicker, more direct than the effect of verbal signals
- Non verbal is a subconscious reflex, so more genuine
- Body language and facial expressions are continuous, vs communication is discontinuous
How do you convey sincerity and concern?
direct eye contact
nodding of head in agreement
facing the patient
Promoting Retention
- Told first
- Believe is important
- Repeated to them
Provide important info first, stress the importance, use short words to be specific, repeat key points
Hearing
attention to sounds and literal interpretation of their meaning
Listening
grasping true meaning of what is being communicated through verbal and non-verbal cues
Hindrances to listening
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
Strategies to enhance interview process
Listening
Environment
Retention
Environment strategies
people need privacy
minimal noise
low level of distractions
control frequency of interruptions
remain in clothing
Patient Centered Interview
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
Results of patient centered medicine
- increased patient knowledge
- more accurate risk perceptions
- greater number of decisions consistent w/patients values
- reduced level of internal decision conflict
- less chance of patient remaining passive or undecided
Traits of Expert Clinicians
listen well
educate patient
hands on
detect confusion
seek clarification
Communication Challenges
Confusion
Hearing deficits
Anger
Depression
Confusion
try asking 1 question at a time
restate/summarize what pt told you
avoid medical jargon
rephrase questions
change to close ended questions
Hearing Deficits
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
Anger
Confirm the observations about their anger
stay calm and relaxed to defuse the situation
Depression
may need to reprioritize questions
HEP may need reprioritization
can determine if there is imminent harm to patient
History
provides info about disorder, who the patient is, and guides in formulating a working diagnosis
identify past medical history, and present illness
Red flag S/S
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
Yellow flag S/s
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
Cancer Red flags
persistent pain at night
constant pain anywhere in body
unexplained weight loss
loss of appetite
unusual lumps or growths
unwarranted fatigue
Red flags Cardiovascular
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
Gastro/Genitourinary Red Flags
severe abdominal pain
frequent heartburn or indigestion
frequent nausea or vomiting
change in or problems w/ bowel or bladder
unusual menstrual irregularities
Neurological Red Flags
changes in hearing
frequent or severe headaches w/no injury
problems w/swallowing or changes in speech
fainting spells
sudden weakness
changes in personality
Miscellaneous Red Flags
fever or night sweats
severe emotional disturbance
swelling or redness in any joint
Misc Yellow Flags
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
History questions
- MOI
- Aggravating/relieving factors
- 24 hour history
- improving/static/worse
- new/old injury
- past history
- diagnostic imaging
How do you document a patients statement?
use their own words
Systemic pain
disturbs sleep
deep aching or throbbing
reduced by pressure
constant waves of pain and spasm
is not aggravated by mechanical stress
Musculoskeletal pain
generally lessens at night with rest
sharp or superficial ache
usually decreases w/stopping activity
continuous or intermittent
is aggravated by mechanical stress
Nerve pain
sharp, bright, burning
Bone pain
little radiation of pain
Fracture pain
sharp, severe, intolerable
Vascular pain
diffuse, aching, poorly localized
Muscle pain
hard to localize, dull, aching. Pain on stretch and contraction
Inert tissue pain
pain with stress or pinched
