Patient Centered Interviewing Flashcards
Apart from being knowledgeable, what else makes a good clinician?
- Good communicators
- Empathetic and makes patient feel cared for
- Great bedside manner
- Collaborative
What are the 3 core skills for medical encounters?
- Build and maintain an effective patient-clinician relationship
- Assess and understand the patient’s problem
- Collaborative management
Why is professionalism important?
• You have 7 seconds to make a good impression
* Dress code matters * Patients prefer clinicians who are dressed in formal attire and white coats→ associated with trustworthiness, being knowledgeable, caring and approachable * Impressions depended on type of physician:
* Surgery and emergency rooms→scrubs with white coats
* Primary care and hospital physician→formal attire with white coat
What are the types of communication skills used by Clinicians?
Open-Ended Skills
- Non-focusing
a. Silence
b. Nonverbal communication
c. Neutral utterances and continuers - Focusing
a. Reflection (Echoing)
b. Open-ended questions
c. Summarizing
—>
Emotion Seeking
- Direct
- Indirect
a. Impact on life, others
b. Belief about problem
—>
Empathy
a. Naming
b. Understanding
c. Respecting
d. Supporting
Describe the Open-Ended skills
- Non-focusing
a. Silence
b. Nonverbal communication
c. Neutral utterances and continuers - Focusing
a. Reflection (Echoing)
b. Open-ended questions
c. Summarizing
What are the Non-focusing Open-Ended Skills?
- Silence: The physician says nothing which prompts the Pt to fill the gap with information that might be on their mind
- Nonverbal communication: use of body language and facial expressions to encourage the Pt to speak freely and to show that the physician is listening
• Examples: eye contact, leaning forward, nodding
Use behaviors to show you are listening and interested
- Neutral utterances & continuers: there are non-committal statements that encourage the Pt to continue speaking without the physician directing the conversation
• Examples: “uh huh”, “go on”, “uhmmm”
What examples of listening behaviors should be maintained?
DO:
• Maintain eye contact
• Use body postures that show interest→lean forward, open body position, etc.
- DO NOT:
- Slouch, cross your legs/hands, tap your legs (or any other nervous signs)
- Hide behind a desk
- Drink coffee while talking
- Read or write in the chart while trying to listen
What are the focusing open-ending skills?
- Reflection (Echoing): When the physician repeats a word or phrase that was said by the Pt, it lets the Pt know that they are being heard. It encourages them to continue speaking.
- Open-ended questions/statements: this focuses the Pt on already mentioned information that the physician wants expanded. This allows for a more detailed discussion on a topic.
- Summarizing or Paraphrasing – the physician recaps information collected from the Pt especially after a long discussion. This ensures that the information collected is accurate and allows for clarification.
What are the Close-Ended skills?
• These skills limit the response from the Patient
• They are used to confirm or refute specific information or redirect a Patient who is
longwinded
• These types of questions should be used sparingly
What are the types of emotion seeking skills?
Direct:
• Most times this is a follow-up from a non-verbal cue from the Pt.
• The physician asks the Pt a suitable variation of the open-ended question,
“how did that make you feel?”
• Avoid any form of judgement→“You must be so excited about being pregnant!”
Indirect:
• Sometimes a Pt might not respond to a direct inquiry about their emotion.
• Find indirect ways to explore emotions and feelings without directly
acknowledging it
a) What does the Pt think is the cause of the problem
b) How has it impacted their life, family, friends
c) Why did they come to the physician now
d) What are their expectations
What are the empathy skills?
- Many persons believe that empathy is an inborn trait that cannot be taught.
- However, research shows that medical students who are not taught empathic communication will become clinicians who show little empathic abilities and decreased levels of empathy for their patients over time.
- After the patient has expressed an emotion (verbal or non-verbal), the clinician should express empathy to show that the patient is understood and cared for.
- Empathy = feeling with or alongside someone vs Sympathy = feeling sorry for someone
How can empathy be used as a tool to promote partnership between clinician and patient?
Patient: • Increases patient satisfaction • Builds trust • Improves treatment compliance and coping skills • Decreases anxiety
Medical student:
• Reduces burnout (higher levels of empathy correlated with lower levels of burnout)
Clinician:
• Enriches the clinician-patient relationship
• Reduces malpractice complaints
What is the significance of NURS in empathy skills?
Naming – repeat the expressed emotion to show that you have heard the Pt
Understanding – deepen your understanding of the emotion by asking exploring questions. Acknowledge that the Pt’s emotion is understood
Respecting/Praising/Acknowledging – show appreciation, acknowledge how difficult things have been for the Pt. Praise their efforts.
Supporting – indicate to the Pt that you are prepared to work together as a team to find a solution to their problem.
What is the format of a clinical encounter ?
- Greeting and Introduction
- Setting the agenda
- History taking
- Physical examination
- Assessment
- Plan
How should physicians conduct greetings and introduction?
a) Knock before entering:
• This is the first trust building step, and it shows respect
• Knock x3, wait 3 seconds then enter the room→enter after 3 seconds even if no response
b) Introduction:
• This sets the tone for the interview
• Use your “title + first + last name + role” OR “title + last name + role”
• Always maintain eye contact
• If you wish, offer a handshake→relaxes patient
• May not always be appropriate
C) Confirm the Pt’s name and how they would like to be addressed
D) remove barriers to communication
• Sit to the right of the Pt at a 45-degree angle approximately 2-3 feet away
• Eye contact
• Ensure Pt readiness, comfort and privacy
• Give Pt an idea of what to expect for the session
