patient encounter

Question 1

how do you set up the patient-care atmosphere

Answer 1

1. Welcome the patient
2. Use the patient’s name
3. Introduce yourself and identify specific role
4. Ensure patient readiness and privacy
5. Remove barriers to communication
6. Ensure comfort and put the patient at ease

Question 2

Eliciting patient concerns =

Answer 2

CC, thing(s) pt wants to address today

Question 3

Letting patients express all their concerns avoids:

Answer 3

1. Missed diagnoses
2. Angry patients
3. Frustrated clinicians

Question 4

2 approaches when setting an agenda

Answer 4

1. Open ended question
   Negotiate priorities
   Orient patient to the flow of
   the encounter
2. Indicate time available
   Forecast what needs to happen at today’s visit
   Obtain a list of all the patient’s problems
   Summarize and finalize visit agenda

Question 5

2 types of barriers to eliciting concerns

Answer 5

patient factors
provider factors

Question 6

7 patient factors that act as barriers to eliciting concerns

Answer 6

1. Time
2. Embarrassment
3. Language barrier
4. Intimidated
5. Deaf (Sensory barriers)
6. Trust
7. Mental handicaps

Question 7

8 provider factors that act as barriers to eliciting concerns

Answer 7

1. Time
2. Hypocrisy
3. Provider bias/prejudice
4. Cultural differences
5. “Frequent fliers”
6. Keeping your composure
7. Personal or emotional conflicts
8. Patient being inattentive

Question 8

2 major portions of Hx of present illness

Answer 8

1. patient-centered
2. clinican-centered

Question 9

6 components of patient-centered HPI

Answer 9

1. open-ended beginning statement
2. attentive listening
3. nonverbal sources
4. focusing open-ended skills
5. emotion-seeking skills
6. empathy skills (NURS)

Question 10

80% of patients will finish their statement in ____ if allowed to speak

Answer 10

<2min

Question 11

6 nonverbal sources

Answer 11

1. Nonverbal cues
2. Physical characteristics
3. Autonomic changes
4. Accoutrements
5. Environment
6. Self

Question 12

what makes patient-centered and clinician-centered HPI different

Answer 12

clinician - interview shifts to specific, more closed-ended questioning

Question 13

4 components of clinician-centered HPI

Answer 13

1. obtaining and describing data - 7 parameters, ROS
2. impact of illness on self/others
3. health beliefs
4. triggers for seeking care

Question 14

10 common social factors when dealing with pts

Answer 14

1. Rural areas
2. Religion
3. Poverty
4. Education level
5. Societal norms/”fad illnesses”
6. Family situation/influences
7. Stigmas around conditions/diseases
8. Patient pride
9. Change in appearance or lifestyle
10. Ethnic backgrounds

Question 15

how much can be forgotten by the patient about what is said by the provider

Answer 15

up to 40%

Question 16

4 key points to cover for pt education

Answer 16

1. Assessment of patient understanding
2. Communication at patient level
3. Tailor your education for each patient:
   - Maintenance of health
   - Prevention of disease or illness
   - Specific disease states as necessary
4. Self-management education
   - health behaviors (exercise, stress management)
   - consumer behaviors (reading about new treatments, food information)
   - disease-specific behaviors (blood sugar monitoring, support stockings)

Question 17

7 Benefits of Shared Decision Making

Answer 17

1. More likely to feel secure in the healthcare setting
2. Stronger commitment to recover
3. Improved perception of the quality of care
4. Better self-efficacy and patient responsibility for their outcomes
5. Improved self-management
6. Better adherence to care plans
7. Strengthens provider-patient bond

Question 18

3 disadvantages of shared decisions

Answer 18

1. Patient may not desire to make decisions or feel comfortable making decisions
2. Patient misunderstanding may lead to incorrect decisions
3. Associated with increased costs and services in hospitalized patients

Question 19

2 steps of shared decision making

Answer 19

1. Start the discussion by summarizing H&P findings and/or any diagnostic test results you already have and what they mean
2. Explain the most likely diagnoses and patient’s options for further testing and treatment

Question 20

things to consider during shared decision making

Answer 20

• Many patients are not aware that they can or should participate in the decision making
• Some decisions only need a clear statement of what you want to do and why
• Some decisions are more complex and require more discussion and input
• Some health care decisions may be controversial
• Some decisions that require significant behavior changes require more than just explanation and “teach-back”

Question 21

steps in ending the visit

Answer 21

1. summarize convo and plan
2. make sure pt has all the materials needed
3. Always check for any further questions and ask if there is anything else you can do for the patient
4. Acknowledge and support the patient

Question 22

5 patient factor barriers to ending the visit

Answer 22

1. Failure to comprehend education
2. Continuous questions
3. Casual conversation
4. New complaint at end of encounter
5. Family members

Question 23

4 provider factor barriers to ending the visit

Answer 23

1. Poor flow of patient encounter
2. Lack of proper communication with patient
3. Failure to “enforce” the end of the visit
4. Casual conversation