ICM Quiz #1 Review

Cole/Bird Foreword to the 1st Edition, Preface, Ch. 1- 12 and 25 Bates pp. 3-4, 6-10, 55-73 Syllabus material from SGMs 1-3 Appendices assigned during SGMs 1-3 Dr. Massies lecture on Patient Centered Interviewing Dr. Stamms lecture on Infection Control Senior Mentor Program Orientation

1. Cole/Bird Forward, Preface, Ch1-3, 6; Bates 58-63; Appendix B a. Cole/Bird i. Interviewing takes place in a three step approach: building an effective doctor patient relationship; assessing the patients problems and managing the patients problems. 1. Building the relationship: attending to the emotional domain of the patients problems 2. Assessing the patients problems: collect accurate information in a time-efficient manner. 3. Managing the patients problems: allows the patient to be educated on the problem and to be motivated to adhere to treatment recommendations. ii. Building the relationship: 1. Nonverbal skills 2. Empathy 3. Reflection: I can see this is upsetting to you. 4. Legitimation 5. Personal Support 6. Partnership 7. Respect iii. Common Concerns 1. Why should the patient want to talk to or be examined by a student 2. Is a student interview or examination humiliation or indignity for the patient 3. How should I dress? Should I wear a white coat 4. Should I introduce myself as doctor? I I do that am I not deceiving the patient 5. If the patient is in pain or emotional distress, should I continue with the interview? 6. Should I shake the patients hand Under what circumstances is it acceptable to touch a patient. 7. If the patient asks me a question, should I answer the questions if I know the answers? What should I do if I do not know the answers

ICM Quiz #1 Review 8. What do I do if the patient starts crying or if the patient gets angry with me? 9. What should I do if the patient tells me something his or her doctor does not know? For example, what if the patient tells me that he or she is depressed and suicidal. 10. What should I do if the patient promises to tell me some important secrets if I agree to maintain his or her confidence? b. Bates: i. Active listening1. pay close attention to what the patient is communicating 2. be aware of the patients emotional state 3. using verbal and nonverbal skills to encourage the speaker to continue and expand upon important concerns. ii. Empathic responses 1. Identify with the patient and feel the patients pain as the clinicians own. 2. Reply with understanding and acceptance iii. Guided questioning 1. Technique for facilitating full communication, in the patients own words, without interruption 2. Types a. Open ended then focused questions b. Using questions to elicit a graded response- how many stairs can you climb before getting tired c. Asking a series of questions, one at a time- do you have any of the following problems d. Offering multiple choices for answers- when you could was it dry or did you cough up phlegm e. Clarifying what the patient means- tell me what you meant by the stomach flu f. Encouraging with continuers- go on. Im listening. g. Using echoing- Repeating patients statement in question form. iv. Nonverbal communication 1. Your body position and facial expressions speak to patients also v. Validation 1. Help the patient view their emotions and concerns as legitimate. vi. Reassurance 1. Reassure the patient that their problem has been understood and is being addressed.

ICM Quiz #1 Review vii. Partnering 1. Make patients feel that regardless of what happens with their illness,, you will be part of their care viii. Summarization 1. Give a capsule of the patients story during the course of he interview ix. Transitions 1. Now Id like to ask about your past health issues. x. Empowering the patient 1. Reinforce the patients responsibility for their health 2. Evoke patients perspective 3. Follow the patients lead c. Appendix: 2. Cole/Bird Ch. 4,5,25; Bates 55-70; Appendix D/E a. Cole/Bird i. Assessing the patients problems: 1. Nonverbal listening behavior 2. Open ended questions then the open to close cone 3. Facilitation 4. Clarification and direction 5. Checking 6. Surveying problems 7. Avoiding leading questions b. Bates: i. Interview and the health history 1. Comprehensive History: new patient 2. Focused-or problem oriented history- established patient history that present with an acute problem. ii. The Interview Sequence 1. Preparation 2. Greet the patient and establish rapport 3. Establishing the agenda 4. Inviting the patients story 5. Exploring the patients perspective a. Feelings b. Ideas c. Function d. Expectations 6. Identifying and responding to the patients emotional cues 7. Expanding and clarifying the patients story

ICM Quiz #1 Review a. OLDCARTS b. OPQRST c. Location, quality, quantity or severity, timing, setting in which it occurs, remitting or exacerbating factors, associated manifestations 3. Cole/Bird Ch. 7-12; Bates 3-4, 6-10; a. Cole/Bird: i. Opening 1. Introduction 2. Establish goals of interview 3. Obtain patient consent 4. Establish initial rapport 5. Establish patient comfort ii. Chief Complain and Survey of Problems: 1. Elicit the chief complaint 2. Responding to emotions 3. Initial facilitation 4. Checking 5. Survey of Problems 6. Probing to completeness 7. Negotiating priorities 8. Patient expectations 9. Patients idea about the meaning of the illness iii. History of Present Illness 1. Link of the chronologic emergence of symptoms with the overall life circumstances of the patient. 2. Seven Content Items a. Location b. Quality c. Severity d. Timing e. Context f. Modifying Factors g. Associated Signs and Symptoms iv. Medical History 1. Hospitilizations 2. Surgeries 3. Illnesses 4. Injuries 5. Medications

ICM Quiz #1 Review 6. Allergies 7. Pregnancies 8. Exposures 9. Health maintenance 10. Psychiatric problems v. Family History vi. Patient Profile and Social History 1. Interpersonal relationships 2. Leisure activities 3. High risk health behaviors a. C (Have you ever felt the need to cut down) b. A (Do you ever get annoyed when people tell you to cut down) c. G (Do you ever feel guilty for using) d. E (Have you ever needed an eye-opener in the morning) 4. High risk life situations a. Can you tell me about the kinds of stress you are under? b. Bates: 3-4, 6-10 i. Comprehensive vs. Focused Interview ii. 7 Components of a health history 1. Identifying data; Reliability 2. Chief complaint 3. Present illness- well characterization of each symptoms; each symptom gets its own paragraph 4. Past history: childhood illnesses, adult illnesses: medical, surgical, ob/gym, and psychiatric, health maintenance 5. Family history 6. Personal and social history 7. Review of systems 4. Cole/Bird Ch. 13; Bates 4-7, 10-12; Appendices F,G,H,I,J,K, and L a. Cole/Bird i. Assessing the patients problems: 1. Nonverbal listening behavior 2. Open ended questions then the open to close cone 3. Facilitation 4. Clarification and direction 5. Checking 6. Surveying problems 7. Avoiding leading questions ii. Ch. 5

ICM Quiz #1 Review iii. Common Concerns 1. Why should the patient want to talk to or be examined by a student 2. Is a student interview or examination humiliation or indignity for the patient 3. How should I dress? Should I wear a white coat 4. Should I introduce myself as doctor? I I do that am I not deceiving the patient 5. If the patient is in pain or emotional distress, should I continue with the interview? 6. Should I shake the patients hand Under what circumstances is it acceptable to touch a patient. 7. If the patient asks me a question, should I answer the questions if I know the answers? What should I do if I do not know the answers 8. What do I do if the patient starts crying or if the patient gets angry with me? 9. What should I do if the patient tells me something his or her doctor does not know? For example, what if the patient tells me that he or she is depressed and suicidal. 10. What should I do if the patient promises to tell me some important secrets if I agree to maintain his or her confidence? iv. Opening 1. Introduction 2. Establish goals of interview 3. Obtain patient consent 4. Establish initial rapport 5. Establish patient comfort b. Bates: 4-7, 10-12