Interviewing

History II

and

Health

Be sensitive to reports or mood

changes or symptoms such as
fatigue, unusual tearfulness, appetite
or weight changes, insomnia or
vague somatic complaints.

Screening questions:
>Over the past 2 weeks, have you
felt down, depressed or hopeless?
>Over the past 2 weeks, have you
felt little interest or pleasure in doing
things?
>Have you ever thought about
hurting yourself or ending your life?

Dr. C. Barredo-Villarosa
Sensitive Topics
Sexual History
Mental Health History
Alcohol and Illicit Drug Use
Family Violence
Death and Dying Patient
Guidelines for Broaching Sensitive Topics
Be nonjudgmental- single most
important rule.
Explain why you need to know
certain information.
Find opening questions for sensitive
topics and learn the specific kinds of
data needed for your assessment.
Consciously acknowledge whatever
discomfort you are feeling.
The Sexual History
Sexual behaviors determine risk for
pregnancy, STD and AIDS.
Sexual dysfunction may result from
use of medication.
Can be introduced at multiple points.
Start with an orienting sentence or
two.
Try to be matter-of-fact in your
style.
Ask about both specific sexual behaviors
and satisfaction with sexual function
When was the last time you had an
intimate
physical
contact
with
someone? Did that contact include
sexual intercourse?
Do you have sex with men, women
or both?
How many sexual partners have you
had in the last 6 months? In the last
5 years? In your lifetime? Do you
always use condoms?
Do you have any concerns about
HIV infection or AIDS?
Mental Health History
Ask open-ended questions initially.
Move to more specific questions.
Depression or Thought Disorder

Alcohol and Illicit Drugs

Avoid
letting
personal
feelings
interfere with your role as a clinician.
Ask about current and past use of
alcohol or drugs, patterns of use and
family history.
CAGE

Questions
Cutting down
Annoyance if criticized
Guilty feelings
Eye-openers
>2 or more affirmative
suggest alcohol misuse.

answers

Family Violence
Clues to possible physical abuse
>If injuries are unexplained, seem
inconsistent
with
the
patients
history, are concealed by the patient
or cause embarrassment.
>If the patient has delayed getting
treatment for trauma.
>If there is a past history of repeated
injuries lr accidents.
>If the patient or person close to the
patient has a history of alcohol or
drug abuse.
>If the partner tries to dominate the
interview, will not leave the room or
seems
unusually
anxious
or
solicitous.
Death and the Dying Patient
Kubler-Ross 5 Stages in a persons
response to loss
Denial and Isolation
Anger
Bargaining
Depression or Sadness

 Acceptance

Comprehensive
History

Health

Structure and Purposes

Comprehensive
Focused
For
new
For
patients
established
Provides
patients
Urgent
care
fundamental
knowledge
visits
Strengthens
Assesses
clinicianfocused
patient
concerns.
relationship
Provides
baselines

Subjective vs Objective Data

Subjective
Objective
What
the
What
you
patient tells
detect on the
you.
examination.
The history,
All
physical
from
chief
examination
complaint,
findings.
through
Example: Mrs.
review
of
G. Is an older
systems.
white female,
Example:
deconditioned
Mrs. G. is a
,
pleasant,
54 year old
and
hairdresser
cooperative.
who reports
BP
pressure over
160/80mmHg,
her left chest
HR
96bpm
which
goes
and
regular,
into her left
RR
24cpm,
neck
and
afebrile.
arm.