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ICM Exam 1 > Week 3 - Patient Communication and Visits > Flashcards

Week 3 - Patient Communication and Visits Flashcards

1
Q

What does ICM mean for a patient visit?

A
  1. Introductions
  2. Comfort
  3. Make yourself comfortable
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2
Q

What is Step 1 for the visit? How long?

A

Set the stage for the interview (30-60 seconds)

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3
Q

4 things with Step 1

A
  1. Welcome (is that how you’d like to be addressed?)
  2. Introduce yourself and role
  3. Ensure pt readiness, comfort, and privace
  4. Remove communication barriers (sit down)
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4
Q

What is Step 2 for the visit? How long?

A

Elicit CC and set agenda (1-2 minutes)

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5
Q

2 things with step 2

A
  1. Indicate time available

2. Agenda negotiation

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6
Q

Is what is most troublesome always what is most serious?

A

No

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7
Q

What is step 3 of the visit? How long?

A

Begin interview w/ non-focusing skills to help pt express themselves (30-60 seconds)

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8
Q

2 things with Step 3

A
  1. Start w/ open-ended request/question

2. Using non-focusing open-ended skills (attentive listening)

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9
Q

Should we attemp to corroborate history with non-verbal sources?

A

Yes

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10
Q

Step 4 of visit? How long?

A

Use focusing skills to learn 3 things:

  1. Symptom story
  2. Personal context
  3. Emotional context

3-10 minutes

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11
Q

4 things with Step 4

A
  1. Elicit personal context (pt beliefs/attributions)
  2. Elicit emotional context (direct or indirect emotion seeking skills)
  3. Respond to feelings/emotions (NURS)
  4. Elicit symptom story (echoes, requests, summaries - opened ended skills)
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12
Q

Exam of direct emotional questions

A
  1. How are you doing with this?

2. How does this make you feel?

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13
Q

Example of indirect emotional questions

A
  1. How has this affected your life? (impact)

2. What made you decide to come in now? (triggers)

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14
Q

NURS. Part of which step?

A

Name
Understand
Respect
Support

4

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15
Q

Step 5. How long?

A

Transition to clinician-centered phase of interview (30-60 seconds)

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16
Q

3 things with Step 5

A
  1. Brief summary
  2. Check accuracy
  3. Indicated that both content and style of inquiry will change (switch gears now to better understand)
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17
Q

Step 6 (last step)

A
  1. Orient pt to end of interview
  2. Explain how diagnosis/prognosis was reach’ incorporate pt’s informative needs
  3. Explain testing and/or treatment options; incorporate pt preferences
  4. Acknowledge support before saying goodbye
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18
Q

What 2 things do we do to monitor our relationship with our patients?

A
  1. Inquire how things are going between the two of you

2. Observe pt’s body language, behaviors, etc

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19
Q

Should we consider patient and physician personality?

A

Yes

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20
Q

What are 2 potential issues on the clinician’s side of relationship?

A
  1. What I am FEELING

2. What I am DOING

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21
Q

How do we identify an issue?

A
  1. Which people trouble me?
  2. What happens?
  3. Why does that happen?
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22
Q

2 things to change the behavior

A
  1. Acknowledge the problem

2. Set specific, healthier behavior to maifest

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23
Q

Can anxiety and tension help with identifying a problem?

A

Yes

24
Q

Define Personality.

A

Ways a person thinks, feels, behaves, and interacts in relationships with others

25
Q

Can personality determine how a person responds to stressors or illness?

A

Yes

26
Q

If patients and physicians have same personality, is there better care?

A

Yes

27
Q

Do we adjust our behavior or theirs?

A

Ours

28
Q

Define Abnormal Personality (personality disorder)

A

Maladaptive and interferes with successful functioning

29
Q

Can maladaptive patterns be exacerbated by illness?

A

Yes

30
Q

5 detailed things with “Better-Adapted” Dependent Patients

A
  1. More advice requests
  2. Need detailed directions
  3. Superindependence
  4. Living at home when not necessary
  5. Deferring to spouse
  6. Problematic oral habits
31
Q

4 detailed things with “Maladaptive” Depending Patients

A
  1. Demand urgent attention
  2. Instructions require repetition
  3. Losses/separation of loved ones more stressful
  4. Sense of entitlement
32
Q

Basic Need in “Dependent Style” Patients

A

Decrease fears of abandonment or helplessness learned in early childhood

33
Q

What does a maladaptive “dependent” patient want?

A
  1. Boundless interest
  2. Attention
  3. Care
34
Q

How do we respond to “Dependent” patients?

A
  1. Provide positive outlook
  2. Show interest in them outside of disease
  3. Give guidance
  4. Provide special favors
  5. More frequent visits
35
Q

Basic Need for OCD Patients. Why?

A
  1. Maintain control of emotions, unconscious fears

Excessive childhood punishment

36
Q

How to respond to OCD patients?

A
  1. Give info in appropriate detail
  2. Involve patient actively
  3. Compliment them
37
Q

4 details of better adapted OCD patients

A
  1. More oderliness
  2. Precise speech
  3. Tidiness, punctuality, conscientriousness
  4. Concern with right and wrong
38
Q

5 details with maladaptive OCD patients

A
  1. Want substitutes for feelings and emotions
  2. Rituals for behavior and action
  3. Bring extensive notes about symptoms
  4. Don’t listen
  5. Self-doubt can cause problems with medical decisions
39
Q

Histrionic Basic Need

A

Merge emotionally with others, especially of opposite sex

40
Q

How to respond to Histrionic patients

A
  1. Brief compliments
  2. Show interest in pt as a person
  3. Respond calmy when pt responds seductively
  4. Reassurance works better than explanations
41
Q

Self-Defeating (Masochistic) Style Basic Need

A

Need of persons, need to suffer

42
Q

How to respond to Masochistic Needs

A
  1. Avoid reasurrance, acknowledge their plight
  2. Frame treatment as a burden
  3. Frame interventions in terms of how it will help someone close to them
43
Q

Narcissistic Style Basic Need

A
  1. Overcome low self-esteem and lack of confidence in maintaining personal identity
  2. To be intimate, merging with them and losing individuality
  3. Overcompensate by attempts to be superior and unique
44
Q

How to respond to Narcissists

A
  1. Acknowledging unique pt achievement, show expertise
  2. Engage pt at a medical level
  3. Sharing ideas like they are a colleague
  4. Give them attitude of respect
45
Q

Paranoid Style Basic Need

A
  1. Decrease fear of their own faults, weaknesses, etc
  2. Often severely criticized as childen
  3. Allay unwanted impulses by projecting them onto other people
  4. Suspicion is rigid and intense
46
Q

How to Respond to Paranoid Patients

A
  1. Give full info about plans and treatments
  2. Friendly, courteous approach
  3. Don’t reinforce or ignore patient’s paranoid assertions
  4. Create sense of safety and acknowledge how difficult problems are
47
Q

Schizoid Style Basic Need

A
  1. Protect against disappointment when relating to others

2. Experienced repeated early emotional deprivation

48
Q

How to respond to Schizoid Patients

A
  1. Accepting unsocialbility and not threatening them with closeness or demands for relating
  2. Do not permit withdrawal
49
Q

Does nonverbal communication influence patient satisfaction?

A

Yes

50
Q

Does dissociation between verbal and non-verbal cause a mixed message?

A

Yes

51
Q

What are the 4 categories of non-verbal communication?

A
  1. Kinesics - fascial expression, gestures
  2. Autonomic - flushing or blanching
  3. Proxemics - don’t sit or stand higher than pt
  4. Paralanguage - warm and inviting voice
52
Q

What is non-verbal matching?

A

Interivewer subtly mirrors a patient’s non-verbal expressions for support

53
Q

What is non-verbal leading?

A

Using non-verbal behavior to shift from one state to another

54
Q

What does leading provide a patient with?

A
  1. Confirms non-verbal connectedness

2. Leads pt away from non-productive behaviors

55
Q

How can you help with a mixed message?

A
  1. Indirectly acknowledge disparity

2. Directly addressing the disparity

ICM Exam 1 (7 decks)

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