Medical Communications Lecture Flashcards
6/3/19
***Common interview skills
- ***Open ended questions
- Direct interrogatory questions (yes/no) as you hone in
- Silence at specific moments
- Facilitative terms (pushing them along)
- Understand verbal and nonverbal cues
- assurance
***Medical interview
Communication, the key to successful clinician patient relationships, allows provider to relay information to patient so they may be clearly understood, not unduly frightening, and inspiring trust and confidence in the provider, allows patients to be involved in their care
Objectives of a medical history
-Understand the root of the patient’s problem, get an accurate perception of the patient’s reality, understand patient expectations, provides orderly means of obtaining medical information and recording it
Autonomy
Patient’s need for self determination and ability to make their own decisions
Beneficence
Provider’s inherent need to do good
Non-maleficence
Provider’s responsibility to first do no harm
Utilitarianism
Appropriate use of resources
Duty
Responsibility/obligation of provider to the patient
Fairness and Justice
Balance between autonomy and competing interest of family and community
Deontological imperatives
Duty of the providers established by tradition and cultural imperatives
What to know/be able to do in order to successfully interview
- Facillitate the interview
- Be open and compassionate
- Have basic curiosity
- Be able to transcend cultural and social barriers
- Must know pathophysiologic relationships in order to establish relevance
Useful precision
A chief complaint will dictate how deep the information that is needed must be to proceed
Factors influencing patients’ response to illness
- Cultural, economic, and social factors
- Work, family, finances and social activities
- Demeanor of examiner
Cultural variation
Differences among groups of people in religion, values, attitudes, ritual practices, family structure, language and mode of social organization
What percent of illnesses are handled outside of the formal healthcare setting
80-90%
Genetic polymorphism
Simultaneous occurence of 2 or more alleles of a gene in a given population
Examples of genetic polymorphism
- Blood group A and gastric carcinoma
- Hgb S and sickle cell
African American common concerns
- Maintaining dignity and autonomy
- Fear of not being treated with respect
Latino common issues
- Close family unit
- Hold healthcare institutions with great deal of suspicion
- Family folk healer curandera
- Subscribe to theories of emotional illness and hot and cold theory of disease
Asian American issues
- Emphasis on obligation and authority
- Balance between yin and yang
- Eye contact sometimes not used
***KNOCKS Technique on beginning interview
Knock and ask permission to enter Never use pejorative titles Open ended questions Comfort -acknowledge concerns ***Keep quiet no interrupting patient for at least 2 minutes Space between bodies
Closure of a visit
- Explain what you can provide
- Have you addressed the CC
- Does the assessment provide a plausible explanation
- If CC not addressed, is it planned to address at next visit? Is patient aware of why their problem was not addressed?
- Assure they understand
Active listening
Listening and watching for clues of importance such as non-verbal cues
Ways to avoid dehumanizing patients
Ensure they are capable of seeing, hearing, and responding to you
Rule of 5 vowels
Audio - listen carefully to story
Evaluate - sort information pertinent and not
Inquire - probe areas requiring more clarification
Observation - notice nonverbal cues
Understand - compassion for patients concerns
Family history includes…
three generations