Lecture Material Week 1 Flashcards
If it wasn’t documented…
It wasn’t done
What % of diagnoses come from history alone?
80%
What are reasons for documentation?
Communication with healthcare team Legal compliance (SOC) Reimbursement purposes Quality improvement initiatives Medical Research
What are HCAHPS?
Hospital Consumer Assessment of Healthcare Providers and Systems
What does patient centered approaches emphasize?
Patient values and their perception of illness
psychosocial
What competencies demonstrate patient centeredness?
Genuineness Respect Empathy Professionalism Time-management
What does patient centered approaches produce?
Biopsychosocial patient description
vs. purely disease specific description
What empathy seeking skills should you use?
N- name “This pain makes you angry”
U- understand “I hear you”
R- respect “I see how tough this is and I admire your strength
S- support (statement of wanting to help)
Clinicians interrupt their patients on average after how long?
18 seconds
Aim for 2 min!
What does the data on patient centered interviewing show?
Increase patient satisfaction and adherence
Decreased malpractice and doctor shopping
Improved health outcomes
Less interviewer bias
What is the overview for the H&P?
List of each component
Date Time CC: "..." x HPI PMH FH SH ROS PE Diagnostics \+/- MDM (ER use) Assessment Plan Sign PA-C Print name (Example: Joseph Yonke MPH, MSBS, PA-C)
Describe your steps for starting the interview
Step 1:
Step 1: Setting the Stage Welcome pt Use their name "Mr. Simpson" Introduce yourself Maintain privacy Remove barriers of communication Ensure pt comfort/ sit at their level
Describe your steps for continuing the interview through Step 2:
Step 2: Setting the Agenda Elicit CC w/ open ended ? Indicate time available Review what you expect to discuss Summarize final agenda
How long should you give the pt to talk about CC
~2min should be aimed for
What are some potential barriers to communication?
pt HOH Poor lighting Visual impairments Noisy atmosphere Use of computing Language barriers Patient distrust Cognitive disturbances etc.
Ways to ameliorate barriers:
Ask pt if anything is interfering
Gauge physical impediments and adjust
Sit closer, help with glasses, hearing aides
Keep eye contact, especially when working with a computer
Engage socially
Common pitfalls during interviewing?
Rushing pt Inattentive/ preoccupied Failing to address all pts concerns Standing Privacy & comfort not maintained Frequent interuptions
What types of questions are okay and which ones should be avoided?
Okay: open ended, close ended (yes/no), focused
Bad: Leading
What is the most important component of the interview?
HPI
What are the 7 cardinal features of a symptom?
LOCATES
How many of the cardinal features are required for highest level of billing?
4/7 LOCATES
What does LOCATES stand for?
L-location and radiation O- other symptoms C-character A- aggravating/alleviating T- timing E- environmental factors S- severity (quantifiable)
What other things should you observe about your patient when obtaining HPI?
Body language, appearance, affect, dress
Define pertinent positives
Disease likely given positive test/symptom
Define pertinent negative
Disease unlikely given negative/no test/symptom
Sensitivity (in the interview)
probability of an affirmative answer to a question predicting disease
Can rule out disease with “no”
Example: Meningitis with fever is highly a sensitive
P that presents with no fever, can rule out meningitis
Specificity (in the interview)
Probability of a “no” answer in predicting NO disease
can rule in disease
Example: “Are you experiencing chest pain less than 1 min at a time”
“Yes”
Can rule in ACS in ddx
A strep test will have few false positives. It is therefore highly
specific
Which of the following is NOT an intended reason for good documentation? A. quality improvement B. billing C. avoid litigation D. communication between pt and provider
D
