Week 1 objectives Ch 3

Question 1

Compare and contrast the differences between the interviewing process with the health history form used in documentation

Answer 1

Interviewing Process:
oGenerates patient’s story and is fluid and requires empathy, effective communication, and the relational skills to respond to patient cues, feelings, and concerns
oThe process involves open ended questions
oRequires active listening, guided questioning, nonverbal affirmation, empathic responses, validation, reassurance, and partnering
oThe techniques used in the interviewing process are pertinent to eliciting the patient’s chief concerns and the history of present illness
Health History Format:
oStructured framework for organizing patient information in written or verbal form
oThe format focuses on the specific kind of information that you need to obtain, facilitates clinical reasoning, and clarifies communication of patient concerns, diagnoses, and plans to other health care providers involved in the patient’s care
oThese are close ended yes or no questions and are more pertinent to past medical history, family history, the personal and social history and the review of systems
**For both the most important thing is to actively listen to the patient

Question 2

Be able to describe and demonstrate the techniques of skilled interviewing

Answer 2

Active listening, emphatic response, guided questioning, nonverbal communication, validation, reassurance, partnering, summarization, transitions, empowering the patient.

Question 3

Know the sequence of the interview

Answer 3

Greeting the patient and establishing rapport
Taking Notes
Establishing the agenda for the interview
Inviting the patient’s story
Identifying and responding to emotional cues
Expanding and clarifying the patient’s story
Generating and testing diagnostic hypotheses
Sharing the Treatment plan
Closing the interview and the visit
Taking time for self-reflection

Question 4

Know and be able to explain what FIFE stands for

Answer 4

F: The patient’s Feelings, including fears or concerns, about the problem
I: The patient’s Ideas about the nature and the cause of the problem
F: The effect of the problem on the patient’s life and Function (effect on function)
E: The patient’s Expectations of the disease, of the clinician, or of health care, often based on prior personal or family experiences

Question 5

Cultural Competence

Answer 5

Commonly viewed as “a set of attitudes, skills, behaviors and policies that enable organizations and staff to work effectively in cross-cultural situations. It reflects the ability to acquire and use knowledge of the health related beliefs, attitudes, practices, and communication patterns of clients and their families to improve services, strengthen programs, increase community participation, and close the gaps in health status among diverse population groups.”
Cultural competent care requires understanding of and respect for the cultures, traditions, and practices of a community
Cultural competence is often reduced to a static decontextualized set of traits and beliefs for particular ethnic groups that objectifies patients as other, implicitly reinforcing the perspectives of the dominant culture
This dynamic is often compromised by sociocultural mismatches between patient and provider, typically arise from providers’ lack of knowledge about patient beliefs and lived experiences as well as unintentional or intentional enactment of stereotypes and bias during patient encounters

Question 6

Cultural Humility

Answer 6

Defined as a “process that requires humility as individuals continually engage in self-reflection and self-critique as lifelong learners and reflective practitioners”. It is a process that includes the difficult work of examining cultural beliefs and cultural systems of both patients and providers to locate the points of cultural dissonance or synergy that contribute to patients’ health outcomes. It calls for clinicians to bring into check the power imbalances that exist in the dynamics of clinician-patient communication and maintain mutually respectful and dynamic partnerships with patients and communities

Question 7

What are the 3 dimensions of cultural humility?

Answer 7

Self-awareness, respectful communication, and collaborative partnerships

Question 8

Self-awareness in relation to cultural humility

Answer 8

Learn about your own biases:
oExplore your own cultural identity and ask how you describe yourself in terms of ethnicity, class, region or country of origin, religion, and political affiliation
oLearn about values and biases and bring them to a conscious level
Values: the standards we use to measure our own and others’ beliefs and behaviors
Biases: The attitudes or feelings that we attach to perceived differences
oBeing attuned to difference is normal, it is important not to deny biases, but rather to acknowledge and work on them and not let them effect professionalism

Question 9

Respectful communication in relation to cultural humility

Answer 9

Work to eliminate assumptions about what is “normal.” Learn directly from your patients; they are the experts on their culture and illness. Establish rapport and trust will allow patients to be more willing to teach you. Always be ready to acknowledge your areas of ignorance and bias

Question 10

Collaborative partnerships in relation to cultural humility

Answer 10

Build patient relationships on respect and mutually acceptable plans. Continually work on self-awareness and seeing through the “lens” of others, lay foundation for the collaborative relationship that best supports the patient’s health. Communication based on trust, respect, and a willingness to re-examine assumptions allows patients to express concerns that run counter to the dominant culture

Question 11

Active Listening

Answer 11

The process of closely attending to what the patient is communicating, being aware of the patient’s emotional state, and using verbal and nonverbal skills to encourage the speaker to continue and expand upon important concerns. Allows you to understand the meaning of those concerns at multiple levels of the patient’s experience

Question 12

Empathic responses

Answer 12

: Identify with the patient and feel the patient’s pain as the clinician’s own. To express empathy, you must first recognize the patient’s feelings. You must have a willingness to elicit emotional content, ask about patients feelings. For a response to be empathetic, it must convey that you feel what the patient is feeling

Question 13

Guided questioning

Answer 13

Use questions that show sustained interest in patient’s feelings and deepest disclosures

Question 14

Types of guided questions

Answer 14

Moving from open-ended to focused questions
Using questioning that elicits a graded response
Offering multiple choices for answers
Asking a series of questions one at a time
Clarifying what the patient means
Encouraging with continuers
Using echoing

Question 15

Nonverbal communication

Answer 15

Use nonverbal cues to read the patient as well as send signals to the patient
Pay close attention to your body language
Can mirror patient nonverbal cues such as qualities of speech (paralanguage)
Bringing nonverbal cues to conscious level is crucial for patient interaction

Question 16

Validation

Answer 16

Acknowledge the legitimacy of his or her emotional experience. This allows the patient to feel such emotions are legitimate and understandable

Question 17

Reassurance

Answer 17

The first step to effective reassurance is simply identifying and acknowledging the patient’s feelings (promotes feeling of connection)

Question 18

Partnering

Answer 18

Makes patients feel that regardless of what happens with their illness, that you envision continuing to take care of them

Question 19

Summarization

Answer 19

give summaries of patient’s story during the course of the interview allows the patient to know that you are actively listening, as well as allowing the interviewer to organize the information

Question 20

Transitions

Answer 20

Use appropriate transition phrases that gain patient confidence in the interviewer’s ability to conduct an interview and put the patient more at ease. *Make it clear what the patient should expect or do next

Question 21

Empowering the patient

Answer 21

: Patient is ultimately in control of their own health, thus instilling confidence in the patient leads to patient trusting the medications and following the plan
Evoke the patient’s perspective
Convey interest in the person, not just the problem
Follow the patient’s leads
Elicit and validate emotional content
Share information with the patient, especially at transition points during the visit
Make clinical reasoning transparent to patient
Reveal the limits of your knowledge

Question 22

Techniques to discuss sensitive topics

Answer 22

The single most important rule is to be nonjudgemental
Explain why you need to know certain information
Find opening questions for sensitive topics and learn the specific kinds of information needed for your assessments
Consciously acknowledge whatever discomfort you’re feeling

Question 23

Know what the CAGE questioning is used for and stands for

Answer 23

CAGE questioning is used to screen for addiction
oC: Cutting Down
oA: Annoyance when criticized
oG: Guilty feelings
oE: Eye openers
•Two or more affirmative answers to the CAGE questionnaire suggest alcohol misuse
•If you detect misuse, ask about blackouts, seizures, accidents or injuries while drinking, job problems, conflicts in personal relationships

Question 24

Identify the clues present in physical abuse

Answer 24

• Injuries that are unexplained, seem inconsistent with the patient’s story, are concealed by the patient, or cause embarrassment
• Delay in getting treatment for trauma
• History of repeated injuries or “accidents”
• Presence of alcohol or drug abuse in patient or partner
• Partner tries to dominate the visit, will not leave the room, or seems unusually anxious or solicitous
• Pregnancy at a young age; multiple partners
• Repeated vaginal infections and STIs
• Difficulty walking or sitting due to genital/anal pain
• Vaginal lacerations or bruises
• Fear of the pelvic examination or physical contact
• Fear of leaving the examination room

Question 25

What are the building blocks of ethics in patient care?

Answer 25

Nonmaleficence (primum non nocere), beneficence, autonomy, confidentiality

Question 26

Nonmaleficence (primum non nocere)

Answer 26

First do no harm
In the context of an interview, giving information that is incorrect or not really related to the patient’s problem can do harm. Avoiding relevant topics or creating barriers to open communication can also do harm

Question 27

Beneficence

Answer 27

the dictum that the clinician needs to do good for the patient. As clinicians, actions need to be motivated by what is in the patient’s best interest.

Question 28

Autonomy

Answer 28

Patients have the right to determine what is in their best interest. This principle has become increasingly important over time and is consistent with collaborative rather than paternalistic clinician-patient relationship.

Question 29

Confidentiality

Answer 29

Obligation to not repeat what is learned from or know about a patient. This privacy is fundamental to our professional relationships with patients, very important to not let something slip.