Patient centered interview Flashcards

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1
Q

Purpose of medical interviewing:

A

-To gather information

-To establish a safe atmosphere and trusting relationship with the patient

-To provide patient education (inform and motivate the patient)

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2
Q

Biomedical approach:

A

-Focuses on biological factors

-Defines health as the ‘absence of disease’

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3
Q

Biopsychosocial approach:

A

-Connects biological factors with psychological and social

-Allows for increased understanding of illness and health

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4
Q

Determinants of health:

A
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5
Q

Rationale for improving medical interviewing:

A

-Patients often seek care due to their experience, not their symptom(s)

-Patients often ahve more than one concern

-Being able to tell one’s symptom story is diagnostically useful + therapeutic

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6
Q

Medical interviewing skills:

A
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7
Q

Clinician-centered interviewing:

A

-Clinician in charge of interaction

-clinician-driven priorities and beliefs (bias)

-Interview to elicit symptoms of disease

-typically, more close-ended questioning

-differentiates potential conditions the patient may be suffering from

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8
Q

Patient-centered interviewing:

A

-patient leads interaction

-allows patient to express importance/expectations

-interview to elicit experience of disease (symptoms + personal concerns, feelings and emotions)

-typically uses open-ended questioning

-builds and maintains clinician-patient relationship

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9
Q

Open-ended data-gathering skills:

A

a. non-focusing:
-silence
-nonverbal encouragement (eye contact, hand gestures, leaning forward)
-continuers (ex. “uh-huh”, “hmmm”)

b. Focusing:
-echoing (repeating a word of phrase the patient has said)

-requesting (“go on,” “tell me about your pain”)

-Summarizing (paraphrasing your understanding of what the patient has said)

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10
Q

Close-ended data-gathering skills:

A

-Questions that produce a yes/no answer

-questions that produce brief replies

-multiple-choice questions

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11
Q

Emotion-seeking skills:

A

a. Direct inquiry: ex. “how did that make you feel?”

b. Indirect inquiry:
-Inquiring about impact: (“how has that effected your day-to-day life?”)

-Eliciting beliefs or attributions (“what do you think may be causing your pain?”)

-Intuiting how the patient might be feeling (sharing how your or others might respond)

-Asking about triggers (what made you come to see me about this now?)

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12
Q

Conveying empathy skills:

A

a. Naming the feeling/emotion
-repeating the feeling expressed by the patient (“you felt sad”)
-state the feeling you observed (“you look a little teary-eyed. or “you sound frustrated”)

b. Understand statement (“given what has happened, it makes sense to me.”)

c. Respect (praise, appreciate and/or acknowledge the patients situation)

d. Support (“I am here to help in any way that I can.”)

“NURS”

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13
Q

Examples of interviewing questions:

A
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14
Q

Integrated medical interviewing:

A
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15
Q

(Step 1) Setting the stage:

A
  1. Prepare for patient consult by reading intake form/chart to familiarize yourself with patients problem list, medications, allergies and relevant past medical history
  2. Welcome/greeting the patient
  3. Use patients name
  4. Introduce yourself and identify specific role
  5. Ensure patient readiness and privacy
  6. Address barriers to communication (sit down)

6) Ensure comfort and put patient at ease

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16
Q

(Step 2) Elicit chief concern + set the agenda:

A

1) Indicate time available

2) Forecast what you would like to happen during the interview

3) Obtain a list of all issues the patient wants to discuss (ex. specific symptoms, requests, expectations, understanding)

  1. Summarize and finalize the agenda (negotiate specifics if too many agenda items)
17
Q

(Step 3) Opening the history of present illness (HPI):

A
  1. Start with open-ended questions/statements
  2. Use non-focusing open-ended skills (attentive listening)
  3. Obtain additional data from non-verbal sources: physical characteristics, autonomic changes, accoutrements, environment and self

Non-verbal information:
-physical characteristics: general health, skin and hair color, odor, deformities, habitus (emaciated, disheveled, “uremic” breathing, jaundice, amputated lef, kyphoscoliosis)

-Autonomic changes: heart rate, skin color, pupil size, skin moisture, skin temperature

-Accoutrements or accessories: clothing, jewelry, eyeglasses, tattoos, make-up (ex. expensive jewelry, thick eyeglasses, tattoos and body piercings, no make-up or poorly applied make up)

-Environment: hospital (greeting cards, flowers, photographs)

-Self: aware of your own emotions and reactions to patients

18
Q

(Step 3) Learn patient experience of illness:

A
  1. Obtain further description of the symptom(s) =symptom story
  2. Elicit or develop understanding of personal context (psychological and social)
  3. Elicit or develop understanding of emotional impact
  4. Respond to feelings and emotions with empathy skills (re. NURS)
  5. Expand the story to new chapters
19
Q

(Step 5) Transition to middle of interview:

A
  1. Brief summary
  2. Check accuracy
  3. Indicate that both content and style of inquiry will change if the patient is ready
20
Q

(Step 6) History of presenting illness (HPI):

A

Complete a chronological description of the patient’s chief concern and other active problems.

  1. obtaining & describing data w/o interpreting it:
    a. expand the description of symptoms already introduced by the patient
    b. Describe symptoms not yet introduced in the already identified body system (and general health symptoms)

recall: OLD CARTS (Onset, Location/radiation, Duration, Character, aggravating factors, Relieving factors, Timing, Severity)
-utilizes primarily clinician-centered interviewing skills

  1. Interpreting data while obtaining it: testing hypotheses about the possible disease-causing symptoms.
    a. Describe relevant symptoms outside the body system involved in the HPI
    b. Inquire about the presence or absence of relevant non-symptom data (secondary data) not yet introduced by patient
  2. Understand the patients perspective: impact (meaning) of illness on self/others, health benefits, triggers for seeking care
21
Q

(Step 7) Past Medical History (MH):

A

-Screen for major diseases/diagnoses

-Previous injuries or medical interventions

-hospitalizations

-Immunizations

-Preventative/public health screening (ex. mammography in women >50 years)

-Medications and other treatments

-Allergies and drug reactions

22
Q

(Step 8) Social or Psychosocial History (SH):

A

-Occupation

-Health promotion (diet, physical activity)

-Safety (ex. seat belt use, smoke detectors in home)

-Health screening (ex. cervical cancer, colon cancer hypertension)

-Exposures (pets, travel, illness at home/work)

-Substance use (caffeine, tobacco, alcohol, drugs)

-Personal (living arrangement, relationships/support systems, sexual orientation/practices, stress, mood, spirituality)

-Health literacy

-Hobbies/recreation

-Important life experiences (ex. military service, family relationships)

-Legal issues (incl. Emergency contact)

23
Q

(Step 9) Family History (FH):

A

-Information on contagious, toxic, familial and heritable diseases

Examples:
-Anyone else in your home with similar symptoms?

-What age was your mother and grandmother diagnosed with breast cancer?

24
Q

(Step 10) Review Of Systems (ROS):

A

-Ask about relevant symptoms or any secondary data not yet addressed

-ROS is used as a final screening tool to understand the degree of impact the illness has placed on the patient’s life

-Complete physical exam and discuss results of available laboratory findings

25
Q

(Step 11) End of interview:

A
  1. Share information
  2. Assess understanding, provide written plan/instructions
  3. Invite patient to participate in shared decision making
  4. Close the visit
    -clarify next steps (what you will do, what the patient will do, time of next communication)