Lecture 6: Interviewing w/ 2nd person in room

Question 1

What are some of the positives of having a third party in the room (i.e., loved one) during pt interview?

Answer 1

• Can provide sense of security and comfort
• May provide information otherwise unavailable
• Can use third party to help convince pt to proceed w/ necessary medical procedures
• Can better help you understand the limitations of the patient
• Can help the pt process information he/she may not hear or understand

Question 2

If a third party in the room is interfering w/ the interview of the pt, how is this best handled?

Answer 2

• Is best to focus on them, obtain the info they can provide
• Then respectfully excuse them from the room and thank them for their contribution

Question 3

You should always insist on having some time alone with what pts if a third party is present?

Answer 3

• All adult pts, especially if pt is woman and the third party is a man
• Children

Question 4

When is a good time during the pt encounter to suggest to a third party that they must step out of the room for a little while?

Answer 4

During transition to the PE

Question 5

If a partner insists on staying in the room, even after you have asked them politely to step out some you can complete a PE, what is the next step?

Answer 5

Doc should step out and seek help from your supervisor/security

Question 6

If a family member is being confrontational during your interview with a patient, how is this best handled?

Answer 6

• Gently, but firmly redirect the questioning

or

• Request them step out of the room while you finish interviewing the pt

Question 7

Many states (Missouri included) have state consent laws in regards to minors requesting contraceptives, STI services, pre-natal care, adoption placement, and medical care for ther child that apply to all minors of what age?

Answer 7

Age 12 and older

Question 8

Are physicians allowed to inform a minor’s parents/guardian when the minor seeks services for reproductive care?

Answer 8

• Many states allow, but DO NOT require
• Often times left to the discretion of the physician

Question 9

What is the age of consent for marriage in Missouri?

Answer 9

• Must be at least 15 yo w/ parental consent (at least one parent from each party)
• Must be 18+ to marry w/o consent

Question 10

Any suspicion of child abuse or neglet idenitified by a health care provider must be reported to who?

Answer 10

Children’s Division (Child Protective Services) hotline

Question 11

When should a chaperone be present during a PE?

Answer 11

When performing ANY sensitive exam

Question 12

As a physician once you are suspicious of child abuse or neglect, what are the next steps to take?

Answer 12

• Notify security or law enforcement to be standing by
• Be straight-forward with guardian that there are concerns of abuse or neglect and that you are reporting these concerns to CPS
• At this point the child should be separated from the suspected abuser in order to obtain separate interviews and for their protection

Question 13

Can physicians report concerns of domestic violence without consent of those involved?

Answer 13

Yes, due to the Mandatory Protocol (Domestic Violence and Child Abuse) Act

Question 14

In a pt who has a self-defeating (Masochistic) personality, what approach should the doctor take?

What should the doc avoid?

Answer 14

• Avoid providing reassurance, suggestions for improvement or promises of cures
• Instead, acknowledge the pt’s situation and use a less hopeful, more austere approach

Question 15

Pts w/ Narcissistic personalities typically respond best to what type of approach?

Answer 15

Respect and concern rather than warmth

Question 16

How should a doctor respond to a pt with paranoid personality and what should they avoid?

Answer 16

Respond by being friendly and courteous, but AVOID closeness