Lecture Material Week 1

Question 1

If it wasn’t documented…

Answer 1

It wasn’t done

Question 2

What % of diagnoses come from history alone?

Answer 2

80%

Question 3

What are reasons for documentation?

Answer 3

Communication with healthcare team
Legal compliance (SOC)
Reimbursement purposes
Quality improvement initiatives
Medical Research

Question 4

What are HCAHPS?

Answer 4

Hospital Consumer Assessment of Healthcare Providers and Systems

Question 5

What does patient centered approaches emphasize?

Answer 5

Patient values and their perception of illness

psychosocial

Question 6

What competencies demonstrate patient centeredness?

Answer 6

Genuineness
Respect
Empathy
Professionalism
Time-management

Question 7

What does patient centered approaches produce?

Answer 7

Biopsychosocial patient description

vs. purely disease specific description

Question 8

What empathy seeking skills should you use?

Answer 8

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)

Question 9

Clinicians interrupt their patients on average after how long?

Answer 9

18 seconds

Aim for 2 min!

Question 10

What does the data on patient centered interviewing show?

Answer 10

Increase patient satisfaction and adherence
Decreased malpractice and doctor shopping
Improved health outcomes
Less interviewer bias

Question 11

What is the overview for the H&P?

List of each component

Answer 11

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)

Question 12

Describe your steps for starting the interview

Step 1:

Answer 12

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

Question 13

Describe your steps for continuing the interview through Step 2:

Answer 13

Step 2: Setting the Agenda
Elicit CC w/ open ended ?
Indicate time available
Review what you expect to discuss
Summarize final agenda

Question 14

How long should you give the pt to talk about CC

Answer 14

~2min should be aimed for

Question 15

What are some potential barriers to communication?

Answer 15

pt HOH
Poor lighting
Visual impairments
Noisy atmosphere
Use of computing
Language barriers
Patient distrust
Cognitive disturbances
etc.

Question 16

Ways to ameliorate barriers:

Answer 16

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

Question 17

Common pitfalls during interviewing?

Answer 17

Rushing pt
Inattentive/ preoccupied
Failing to address all pts concerns
Standing
Privacy & comfort not maintained
Frequent interuptions

Question 18

What types of questions are okay and which ones should be avoided?

Answer 18

Okay: open ended, close ended (yes/no), focused
Bad: Leading

Question 19

What is the most important component of the interview?

Answer 19

HPI

Question 20

What are the 7 cardinal features of a symptom?

Answer 20

LOCATES

Question 21

How many of the cardinal features are required for highest level of billing?

Answer 21

4/7 LOCATES

Question 22

What does LOCATES stand for?

Answer 22

L-location and radiation
O- other symptoms
C-character
A- aggravating/alleviating
T- timing
E- environmental factors
S- severity (quantifiable)

Question 23

What other things should you observe about your patient when obtaining HPI?

Answer 23

Body language, appearance, affect, dress

Question 24

Define pertinent positives

Answer 24

Disease likely given positive test/symptom

Question 25

Define pertinent negative

Answer 25

Disease unlikely given negative/no test/symptom

Question 26

Sensitivity (in the interview)

Answer 26

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

Question 27

Specificity (in the interview)

Answer 27

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

Question 28

A strep test will have few false positives. It is therefore highly

Answer 28

specific

Question 29

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

Answer 29

D