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GOALS of medical interview 1. Accuracy 2. Efficacy 3. Supportiveness FUNCTIONS of medical interview 1. Determine the nature of the problem 2.

Develop and maintain therapeutic relationship 3. Communicate information and implement treatment plan PHASES OF INTERVIEW *Preparation y Arrange setting has to be quiet, private, comfortable, lighted y Protect your time best if there will be no interruptions y Paper tools Outline, take notes y Review of chart, set goals 1. Starting the interview - Establish rapport (process) - Identify the reason for consult (content) *process=non-verbal language *content=verbal/what the patient says 2. Interview Proper - Assessment, rank the problems, transitions, gather info, build relationship, explain, and plan 3. Conclusion of interview Now, the details of each phase I. In STARTING THE INTERVIEW you need to have the KSA Knowledge, Skills, Attitude Knowledge about (1) the format of the medical history, (2) diagnosing a medical illness, and (3) interview techniques. Format of Medical History General Data, Chief Complaint History of Present Illness Past Medical History- Ch & Adult: Ob Gyn, Psych Family History Med & Psych D/O Personal & Social History Substance Use Review of Systems

Skills in: giving proper introductions, giving purpose and overview of what to expect, giving opening word, listening, and assuring confidentiality. Attitude: be courteous, respectful, helpful, confident, professional, genuine, honest, empathic, understanding, and patient. Six Strategies in establishing rapport 1. Put the patient at ease & address discomfort 2. Find the pain & show compassion 3. Gain trust & become an ally 4. Show expertise 5. Establish authority as MD 6. Balance all roles 1. Put the patient at ease & address discomfort If the patient is timid, shy, anxious, scared: You ll observe: (-) Eye Contact, Stooped, Sit Far, Quivering, Crying, (-) Say Much What you should do: Allow Companion, Smile, Calm Voice, Pat Back, Use patient s Words, Show Understanding & Concern, Encourage, Give Reassurance, Acceptance If the patient is intrusive: You ll observe: Expose to His Breath, Spit, Talkative, Touch You & Things, Rearrange Furniture, Turns on Radio, Feet on Desk, Tense, Erect, Chin Up What you should do: Move Back, Desk as Barrier, Tell Px Stop, Raise Your Voice, Firmly Set Limits & Boundaries, Assert Authority, Remain Professional, Show Expertise, Refocus/ Direct 2. Find the pain & show compassion Fact- Signs and symptoms, Chief Complaint Emotions- patient s feelings/Rxns to S/S MD Should Show Interest Respond w/ True Empathy & Compassion 3. Gain trust & become an ally -Split off Sick vs Participative Role in Treatment (participative is better) -Set therapeutic goals and discuss

SY 2011-2012

Subject: Physical Diagnosis Topic: Interviewing & Communication Skills II Lecturer: Dra. Genuino Date of Lecture: June 15, 2011 Transcriptionist: Orma Pages: 4

-know the patient s level of insight Six Levels of Insight 1. Complete Denial 2. Aware but Deny 3. Aware and Blame Ext Factor 4. Aware- Unknown 5. Aware of Own Contribution but No Change 6. Aware and (+) Bvr Change 4. Show expertise -Put Illness in Perspective- Disease vs Illness -Show Knowledge -Deal w/ Distrust 5. Establish authority as MD -Take Responsibility for Px s Welfare 6. Balance all roles -MD: Empathic Listener, Expert, Authority -Px: Carrier of Illness, Sufferer, VIP -Role Interaction II. INTERVIEW PROPER A. Content- actual verbal language - Greet Px, Introduce Self, Define MD Role - Clarify Expectations- Get Informed Consent - Explore Chief Complaint Why Px here now? - Get Patient s Story- History of Present Illness - Gather Info To come up with diagnosis and treatment plan? - Expand & Clarify History - Generate & Test Hypotheses - Create Shared Understanding of Problem - Use Words Px Understands - Ensure Time Sequences Clear - Neutralize Incorrect Information - Explain Need to Ask Offensive Question - Assess How Problems Affect Px- ask Feelings/ Reactions 7 Attributes of a Symptom 1. Location 2. Quality 3. Quantity/ Severity 4. Timing 5. Setting 6. Remitting/ Exacerbating Factors 7. Associated S/S Explore Patient s Perspective y Ideas Nature & Cause of Illness y Feelings, Fears, Worries, Rxns y Expectations from MD y Effect on Life y Personal/ Family Experience y Therapeutic Responses Explain and Confirm Patient s understanding y Simplify Complex Info Set in Familiar Context, Link Ideas w/ Individual, Image/ Metaphor

y y y y

Categorize Prioritize Repeat Ensure Comprehension

Accentuate the Positive y Explain health benefits y give hopeful note Rank the problems y focus on the problems and list them according to importance (ranking) Negotiate Plan y Further Evaluation, Treatment, Follow up y Explain Rationale for Lab y Give Px Chance to Contribute y Offer Treatment Choices y Assign Tasks & Clarifying Responsibilities y Check w/ Px B. Process- Interaction; What Occurs Non Verbally between Dr-Px.; Non Verbal Message Build Rapport y Give Full Attention y Eye Contact y Listen, Show Interest y Friendly y Clarify, Reflect, Appropriate Responses y Apologize for Interruptions Show Empathy 5 TYPES OF VERBAL RESPONSES - Reflection - Legitimization - Support - Partnership - Respect Non Verbal Responses - Tone of Voice, Face, Touch, Nod Pick-up the Clues y Non-VERBAL Observe Px Feelings, Rxns, Behavior & Hidden Msg thru Body Language, Facial Expression, Gestures, Speech Patterns & Explore y VERBAL Follow Px Lead Ensure the Patient can hear you y Remember your patient name Communicate Rapdly/Slowly Listen more (take note of repeated concerns) Exhibit Neutral approach Ignore potential provocation Be honest, realistic, and straightforward Admit ignorance o Don t get upset if your px keeps on asking you. If you don t know the answer to the

question, just say you ll look into it and will get back to him. Ensure privacy Reassure confidentiality Attend to factors o Encourage/Limit disclosures Encourage patient to continue Don t dominate

Special Issues Patient refuses medical advice due to: 1. Denial of Illness brought about by Fear Consequences of Illness : MD Should a) Assess Patient s Understanding of Illness & Its Treatment b) Talk to Family 2. Cognitive Impairment MD Should Treat Organic Condition 3. Non-compliance with treatment MD Should a) Simplify Treatment Regimen, Discuss Alternatives b) Address Financial Constraints c) Talk to Family d) Warn Consequences of Non-Compliance 4. Patient being hypochondriac MD Should a) Acknowledge Px Suffering b) Address Complaints c)Avoid Extensive Referrals & Diagnostic Procedures d) Maintain Regular Appointments e) Refer to Psychiatry 5. Patient dying MD Should a) Work Thru Own Discomfort re Death b) Be Aware re Stages of Death & Dying c) Understand Px Feelings & Rxns d) Take Time Talk to Px & Family Modifications to Silent patients Meaning of Silence: Collect Thoughts, Recall Details, Trust MD w/ or w/o Info, Shy, Offended, Depressed, in Pain or Dyspnea MD Should 1) Be Observant, Attentive, Encouraging 2) Shift Inquiry, Explore, Ask Px 3) Talk to Family Modifications to Crying Patients Meaning of Crying: Sad, Angry, Frustrated MD Should 1) Pause, Gently Probe, Empathize, 2) Allow Px to Cry, Work Thru Own Discomfort re Cry 3) Show Understanding & Accepting Attitude to Px Suffering Modifications to Angry Patients Meaning of Anger: Suffer Loss of Control, Feelings of Powerlessness, Displaced Feelings, Justified

Transitions y Interrupt with care y Say yes/no tactfully y Engineer abrupt topic changes y Invite feedback Doctor s Responsibilities y Diagnose px illness y Maximize px functioning y Minimize plan y Provide solace and treatment Expectations of a Sick Patient y Exempt from Normal Social Responsibilities y Not Blamed for Illness & Can t Recover by Self y Obliged to Desire Getting Well y Obliged to Seek Competent Care MODELS OF PHYSICIAN-PATIENT RELATIONSHIP 1. Activity-Passivity Model 2. Guidance-Cooperation Model 3. Mutual Participation Model Activity-Passivity Model y Parent- Infant Relationship y MD = All Powerful y e.g. Px Under Anesthesia, Trauma Cases Guidance-Cooperation Model y Parent Child or Teacher-Student Relationship y MD = Dominant & Controlling Mutual Participation Model y Adult Adult Relationship y MD Facilitates Px to Help Self Get Well Components of a doctor-patient relationship y Trust & Confidence y Instillation of Hope y Minimization of Fear & Doubt y Empathy y Personal Relationship Associated w/ Concern y Communication y Informed Consent y Explanation of Treatment Options in Simple Terms so that Px Understands Diagnosis, Therapeutic Procedures, and to eventually arrive at Px s Decision Based on Own Analysis of Info Given

MD Should 1) Remain Relaxed, Non Threaten, Accept & Allow Expression 2) Acknowledge Feelings, Make Amends if Needed, Validate w/o Agreeing 3) Beware of Danger, Explore Solutions & Preventive Measures Modifications to Confusing patients Meaning of Confusion: Multiple S/S, OMD MD Should 1) Focus on Meaning of Symptoms 2) Do MSE if Suspect Psychiatric Problem instead of Explore S/S 3) Refer to Neuro or Psych Modifications to Patient with Limited Intelligence MD Should 1) Assess Schooling & Ability to Function Independently 2) Determine Level of Intelligence- Devt Milestones, Do MSE 3) Get Info from Family 4) Don t be Condescending 5) Refer to Neuro or Psych Modifications to Adolescent Patient MD Should 1) Warm, Respectful Manner 2) Establish Rapport 3) Clearly Stated Questions, Asked Directly & Simply 4) Concern Illness Effect on Teen Activities & Relationships Modifications to Child Patient MD Should 1) Nurturing Attitude 2) Establish Rapport 3) Language at Level of Child s Understanding 4) Use of Play & Fantasy 5) Allow Family to Remain w/ Child if Hospitalized Modifications to Elderly Patient MD Should 1) Show Interest, Patience, Gentleness 2) Establish Rapport & Trust first Before Tackling Sensitive Issues 3) Address Concerns re: Separation/Loss of Loved Ones as Result of Illness & Hospitalization III. CONCLUSION A. Content Summarize & Thank Px for Sharing Info Give Feedback regarding Diagnosis Provide Clear Info regarding Treatment Options Negotiate Mutually Acceptable Mgmt Plan Shared Decision Making Clarify Roles & Responsibilities

Elicit Px Ideas, Concerns Check if PxUnderstood & Agree w/Plan Questions Reaction, Advice, Set Next Appointment Instructions in Case of ER Reiterate Treatment Plan

B. Process - End Politely, Friendly, Firm, Not Rejecting so that the patient will feel Respected, Understood, Relieved

End of transcription Sorry for simply pasting the ppt and supplying it with just little notes. Paulit ulit lang naman kasi eh hopefully this will suffice. GOD BLESS US! Do not be anxious about anything, but in everything, by prayer and petition, with thanksgiving, present your requests to God. Philippians 4:6