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CMS100 > Patient Centered Interviewing > Flashcards

Patient Centered Interviewing Flashcards

1
Q

What is the purpose of medical interviewing?

A
  • to gather information
  • to establish a safe atmosphere & trusting relationship w/ the pt
  • to provide pt education (inform & motivate the pt)
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2
Q

What does the biomedical model focus on?

A

biological factors

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3
Q

How does the biomedical approach define health?

A

as the ‘absence of disease’

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4
Q

What does the biopsychosocial model connect?

A

connects biological factors w/ psychological & social

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5
Q

What does the biopsychosocial model allow for?

A

increased understanding of illness & health

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6
Q

What was the rationale for improving medical interviewing?

A
  • patients often seek care due to their experience, not their symptoms
  • patients often have more than one concern
  • being able to tell one’s symptoms story is diagnostically useful + therapeutic
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7
Q

What do we need to balance when doing medical interviewing?

A
  • improve experience of their symptoms
  • translate symptoms into a diagnosis
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8
Q

What are the attributes of patient-centred interviewing skills?

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

What are non-focusing open-ended data-gathering skills?

A
  • silence
  • nonverbal encouragement (eye contact, hand gestures, leaning forward)
  • continues (e.g., “uh-huh”)
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10
Q

What are focusing open-ended data-gathering skills?

A
  • echoing (repeating a word or phrase the patient has said)
  • requesting (“go on,” “tell me about the pain”)
  • summarizing (paraphrasing your understanding of what the patient has said)
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11
Q

What are 4 interviewing skills?

A
  • open-ended data-gathering skills
  • closed-ended data-gathering skills
  • emotion-seeking skills
  • conveying-empathy skills
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12
Q

What are components of closed-ended data-gathering skills?

A
  • questions that produce yes/no answers
  • questions that produce brief responses
  • multiple-choice questions
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13
Q

What are components of emotion-seeking skills?

A
  • direct inquiry (e.g., how did that make you feel)
  • indirect inquiry: inquiring about impact, eliciting beliefs or attributions, intuiting how patient might be feeling, asking about trigger
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14
Q

What are components of the conveying-empathy skills?

A
  • name the feeing/emotion
  • understand statement
  • respect
  • support
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15
Q

What is step 1 of the integrated medical interviewing?

A

setting the stage

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16
Q

How long does “setting the stage” take?

A

30-60 second

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17
Q

What are components of “setting the stage”?

A
  1. Prepare for patient consult by reading intake form/chart to familiarize yourself with patient’s problem list, medications, allergies and relevant past medical history
  2. Welcome/ greet the patient
  3. Use patient’s name
  4. Introduce yourself and identify specific role
  5. Ensure patient readiness and privacy
  6. Address barriers to communication (sit down)
  7. Ensure comfort and put patient at ease
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18
Q

What is step 2 of the integrated medical interviewing?

A

elicit chief concern + set agenda

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19
Q

What are components of the elicit chief concern + set agenda step of the integrated medicla interviewing?

A

Indicate time available.

Forecast what you would like to happen during the interview.

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

Summarize and finalize the agenda (negotiate specifics if too many agenda items)

20
Q

What is step 3 of the integrated medial interviewing process?

A

opening the history of present illness (HPI)

21
Q

How long should opening the history of present illness (HPI) take?

A

30-60 seconds

22
Q

What are components of step 3 opening the history of present illness (HPI) that help the patient lead the conversation?

A

Start with open-ended questions/statements

Use non-focusing open-ended skills (attentive listening)

Obtain additional data from non-verbal sources: physical characteristics, autonomic changes, accoutrements, environment and self

23
Q

What are non-verbal information we can receive in of step 3 opening the history of present illness (HPI)?

A
  • Physical characteristics: general health, skin and hair colour, odor, deformities, habitus (emaciated, disheveled, “uremic” breath, jaundice, amputated lef, kyphoscoliosis)
  • Autonomic changes: heart rate, skin colour, pupil size, skin moisture, skin temperature
  • Accoutrements or accessories: clothing, jewelry, eyeglasses, make-up (e.g. expensive jewelry, thick eye glasses, 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
24
Q

What is the 4th step of integrated medical interviewing?

A

learn patient experience of illness

25
Q

How long should the 4th step learn patient experience of illness take?

A

3-10 minutes

26
Q

What are components of the 4th step learn patient experience of illness?

A

Obtain further description of the symptom(s) = SYMPTOM STORY

Elicit or develop understanding of PERSONAL CONTEXT (psychological and social)

Elicit or develop understanding of EMOTIONAL IMPACT

Respond to feelings and emotions with empathy skills (re: NURS)

Expand the story to new chapters …

27
Q

What is the mnemonic for empathy?

A
  1. Name
  2. Understand
  3. Respect
  4. Support
28
Q

What is the 5th step of the integrated medical interviewing?

A

transition to middle of interview

29
Q

What are components of the 5th step, transition to middle of interview, of the integrated medical intervieiwng?

A
  • brief summary
  • check accuracy
  • indicate that both content and style of inquiry will change if the patient is ready
30
Q

What is the 6th step of the integrated medical interviewing?

A

history of presenting illness (HPI)

31
Q

What do you do in the 6th step, HPI, of integrated medical intervieiwng?

A

complete a chronological description of the pt’s chief concern and other active problems

32
Q

What are the steps of obtaining the HPI?

A
  1. Obtaining and describing data without interpreting it:​
    - Expand the description of symptoms already introduced by the patient​
    - Describe symptoms not yet introduced in the already identified body system (and general health symptoms)
  2. Interpreting data while obtaining it: testing hypotheses about the possible diseases causing symptoms​
    - Describe relevant symptoms outside the body system involved in the HPI​
    - Inquire about the presence or absence of relevant non-symptom data (secondary data) not yet introduced by the patient​
  3. Understand the patient’s perspective: impact (meaning) of illness on self/others, health beliefs, triggers for seeking care
33
Q

What does the mneomic OLD CARTS utilize?

A

clinician-centered interviewing

34
Q

What are things to remember when gathering the history of presenting illness?

A

The patient is the expert in their symptoms. ​

Non-symptom information (e.g. imaging, blood work) obtained from the patient is considered secondary information and requires verification.​

Requires translation of patient description of concern to medical terminology

35
Q

What is the 7th step of integrated medical interviewing?

A

past medical history (PMH)

36
Q

What are components of the 7th step, past medical history, of integrated medical interviewing?

A
  • Screen for major diseases/diagnoses​
  • Previous injuries or medical interventions​
  • Hospitalizations​
  • Immunizations​
  • Preventative/ public health screening (e.g. mammography in women > 50yrs)​
  • Women’s health history (menarche, menstrual cycle, contraceptive use, obstetric history)​
  • Medicactions and other treatments​
  • Allergies and drug reactions
37
Q

What is step 8 of the integrated medical intervieiwng?

A

social or psychosocial history (SH)

38
Q

What are components of the 8th step, social or psychosocial history, of integrated medical intervieiwng?

A
  • Occupation​
  • Health promotion (diet, physical activity)​
  • Safety (e.g. seat belt use, smoke detectors in home)​
  • Health screening (e.g. 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 (e.g. military service, family relationships)​
  • Legal issues (incl. Emergency contact)
39
Q

What is step 9 of the integrated medical interviewing?

A

family history (FH)

40
Q

What information are you gathering in step 9, family history, of the integrated medical interviewing?

A

information on contagious, toxic, familial, and heritable diseases

41
Q

Which step are these questions a part of:

Any one else in your home with similar symptoms?​

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

A

step 9: family history

42
Q

What is step 10 of the integrated medical interviewing?

A

review of systems (ROS)

43
Q

What is the ROS used for?

A

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

44
Q

What is done in the ROS, step 10, of integrated medical interviewing?

A
  • Ask about RELEVANT symptoms or any secondary data not yet addressed
  • Complete physical exam and discuss results of available laboratory findings
45
Q

What is step 11 of the integrated medical interviewing?

A

end of interview

45
Q

What are components with step 11, end of interview, integrated medical interviewing?

A
  • Share information​
  • Assess understanding, provide written plan/instructions​
  • Invite patient to participate in shared decision making​
  • Close the visit​
  • Clarify next steps (what you will do, what the patient will do, time of next communication)
46
Q

What are the physical exam used for?

A

prioritize compaint-based physical exam to include relevant assessments that:
- confirm or deny pt’s symptom story
- determine extent of illness
- refine differential list
- assess eligibility for potential treatment option(s)

CMS100 (6 decks)

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