Physician/Patient Communication

Question 1

What is a reflective statement?

Answer 1

Strategy utilized to let a patient know you are actively listening to them. Includes Echoing and Summarizing

Question 2

What is Echoing?

Answer 2

Repeating a word the patient uses back to them.
Pt: “It was very difficult”
Dr: “Difficult? How?”

Question 3

What is Summarizing?

Answer 3

Taking a long story the patient says and repeating it back to them in a couple of concise sentences

Question 4

What is Mirroring?

Answer 4

Nonverbal communication skill where you start to use the same nonverbal cues (talking with hands, tilting of the head) as the patient.
A way to express empathy

Question 5

Your mom is suffering from anxiety about you being an ER doctor. She asks if you can prescribe her a shiny new Benzo. What do you tell her?

Answer 5

You can’t because this is considered unethical and in violation of a professional physician-patient boundary.

Other unethical behavior: Sleeping with patients (obvi)

Question 6

What are some examples of “gray areas” when it comes to physician-patient relationships?

Answer 6

1. Prescribing meds for a person not established with you.

2. Providing money to a pt. for their prescription (probably more wrong than right)

Question 7

What is motivational interviewing?

Answer 7

Focusing the conversation on the patient in a goal directed and non-confrontational way.

Question 8

4 steps of motivational interviewing

Answer 8

1. Open-ended Q’s
2. Affirmations
3. Reflective Listening (mirroring, summarizing, echoing)
4. Summaries

Question 9

Describe the stages of the Transtheoretical Model of Behavior Change

Answer 9

1. Precontemplation- not even considering change “I don’t need to lose weight”
2. Contemplation- Thought about it, but probably not “Maybe a few pounds, but I like my cheeseburgers”
3. Preparation- Wants to change, planning on it “Got a gym membership and bought healthy food”
4. Action- “First workout!”
5. Maintenance- Down 50 lbs. and keeping it off

Some sources include relapse, but not here.

Question 10

What is a Controlled Substance Agreement (CSA)?

Answer 10

Signed contracts between patient and physician that states education and expectations by both parties when writing a prescription for a controlled substance.

Question 11

What is the most important fact to make clear when making verbal agreements with patients?

Answer 11

The FINAL decision will be made in the future, and what is said today is not binding.

” If you lose weight, I MAY be able to get you off your BP meds.”

Question 12

What are the 4 criteria that demonstrate a person’s capacity to give informed consent?

Answer 12

1. Understand the situation
2. Understand consequences
3. Demonstrate reasoning in their thought process
4. Can communicate their wishes

Question 13

Risk factors for impaired medical decision-making capacity

Answer 13

<18y
>85y
Neuro conditions
Psych problems
Low education level
Cultural/language barriers

Question 14

What is implied consent?

Answer 14

Physician performs actions with patient permission but does not go through risks and benefits.
Example: In-office PE. Still have to ask pt for permission, but don’t need to go through everything.

Also applies to patients who are ALOC.

Question 15

Strategies to use when there is a language barrier with a patient

Answer 15

Use a certified interpreter (not family)
Allow Extra Time
Use “teach back” strategy- patient explains back to physician
Document the interpreter’s name in the EMR