Medical Interviewing midterm

What are the patient goals during an interview?

Relief of discomfort or worry

search for answers and treatments about their illness

What are the PAs goals during an interview?

explain the problem

determination of therapeutic plan

provide patient education

What is the most important part of conducting a patient interview and the first step towards connecting with your patient and establishing a therapeutic relationship?

Active listening

What are the 4 pillars to connecting with patients ?

Respect

Empathy

Genuineness

Professionalism

First step in interviewing a patient is?

remove your own beliefs, prejudices and preconceptions from your observations

What is a non judgmental attitude in a clinical relationship?

promoting trust, cooperation and a more holistic approach to healthcare

What is respect in a clinical relationship?

This involves acknowledging and valuing the patients perspectives even if they differ from the healthcare providers own beliefs

What is Genuineness in a clinical relationship?

Understanding and sharing the patients feelings and experiences without imposing personal biases

What is objectivity and active listening in a clinical relationship?

Encouraging open and honest communication by creating a safe space where patients feel comfortable expressing themselves.

What is empathy in a clinical relationship?

Helps the healthcare provider connect with patients on an emotional level enhancing communication and rapport

What is acceptance of patient in a clinical relationship?

Ensuring that all patients receive equitable and compassionate care is essential for a nonjudgmental approach.

What are the 6 keys to being respectful?

Introduction

Eye contact

Proper address

last name

explain your role

assess comfort

What are the keys to being genuine?

1. know and be yourself

2. explain your role but dont apologise for it

3. dont overstate your knowledge or skills

4. be interested in your patients as people

5. be cautious with opinions

6. be professional

What helps maintain professionalism?

controlling emotions

understanding legal and regulatory requirements

cultural sensitivity

integrity and honesty

maintaining boundaries

self development

conservative and clean appearance

What acronym is used empathy

Name the feeling/emotion

Understanding

Respecting

Supporting

What type of questions do you use for opening the interview?

open ended - to encourage the patient to share their concerns and provide a narrative about their medical history

What type of questions do you use for gathering background information?

CLosed ended - to obtain specific details of pt history

What type of questions do you use for exploring present symptoms?

Open ended - allow the patient to express themselves by using open ended questions when exploring their current symptoms

What type of questions do you use for confirming information?

closed ended - to confirm specific details or clarify information

What type of questions do you use for understanding patient perspectives?

open ended - to delve into patients thoughts, feelings, and expectations regarding their health.

What type of questions do you use for reviewing medical history?

efficiently gather information about the patients medical history, allergies, and medications

What type of questions do you use for assessing severity?

closed ended-to quantify aspects of symptoms

open ended - for a more qualitative understanding

What type of questions do you use for encouraging patient input?

open ended- to invite the patient to share any additional information or concerns they may have

What type of questions do you use for concluding the interview?

closed ended- to wrap up the interview and ensure all questions were answered

What is paralanguage?

verbal qualities such as pauses, tone, rhythm, pace, vibrancy, error volume and articulation in speech

why does a patient pause before answering your question?

for absolute recall

language formation

censorship of information

creating an effect(timing)

preparing to lie

Objective

clinical findings that are observed

Subjective

that which is percieved by the patient

Sign

objective finding as perceived by an examiner

Symptom

subjective indication of disease or change in condition perceived by the patient

Observation

what the patient says or does

Interpretation

specific etiology often used as a shorthand necessary for thinking and holding conversations in the clinical practice

What is precision

characteristic of scientific process that relates to the distribution of observations around the real value

Sensitivity

expresses the tests ability to pick up real cases of the disease in question

Specificity

refers to the tests ability to rule out disease in the normal person

What are the challenges to reliability

patients learn to tell a good story

patients recall new information

patients have beliefs about their illnesses

patients change their stories

interviewing skill matter

Parts of the SOAP note

Subjective

Objective

Assessment

Plan

What is part in the subjective portion of a soap note?

Chief complaint(CC)

History of present illness(HPI)

Past Medical History(PMH)

Family History(FH)

Social History(SH)

Review of Systems(ROS)

What is the chief complaint?

1. what the patient tells you is wrong.

2. in the patients own words

3. usually placed in quotation marks

Ostensible complaint

the complaint you perceive

Actual complaint

actual reason for visit

What is Iatrophic stimulus?

a stimulus or event that prompts patients to seek or receive medical attention

What is the HPI

a chronological description of the progression of the patients present illness from the first sign and symptom to the present

what does OPQRST stand for?

Onset

Provocation or palliation

Quality

Region and radiation

Severity

Timing

What is ROS?

an inventory of specific body systems designed to document any symptoms the patient may be experiencing or has experienced

What is problem pertinent?

Includes the immediate body systems where the problem is most likely

How many systems should be reviewed during a complete visit?

covers nearly all body systems, >10 systems

reserved for annual visits

How many systems should be reviewed during an extended visit?

Includes the nearby surrounding body areas where the problem is most likely 2-9 systems

How to obtain c clinically useful ROS?

stay focused

be efficient

Group in few ( avoid 3+ symptoms in one question)

cover enough

develop flow

be pertinent

What are common pitfalls in obtaining ROS?

not covering enough ROS

wasted time

getting hyper focused on your potential diagnosis

being able to assess whether the symptom is significant or trivial

What make up the associated symptoms in a note?

pertinent positives

pertinent negatives

ROS

4 keys to taking past medical history

1. closed ended line of questioning

2. balance between too little and too much

3. experienced clinicians may need to take notees

4. documented in bullet form

Past medical history

a list of current and past medical conditions such as diabetes, hypertension, asthma, or cancer, other active problems, prior illnesses childhood and adult

Documenting hospitalizations

any significant hospital stays, including the reason for admission and outcomes

Documenting surgical history

Details about past surgeries, including the type, date, and name of the surgeon. Even any complications

Documenting accidents or injuries

include details about the type, cause, date, and treatment

Documenting GYN/Obstetric history

FOr females, information about pregnancies, menstrual history and relevant gynecological details

Documenting psychological history

details about mental health, including any history of depression, anxiety, and other psychiatric conditions

Documenting allergies

Allergy/intolerances to:

medications

foods

contrast dyes

environmental

occupational

What is important when documenting allergies

The allergy and the reaction to the trigger

Documenting medications

Drug name , dosage, route, frequencies

What is included in documenting medications

prescription medications

over-the-counter meds

supplements/vitamins

What is polypharmacy

refers to the concurrent use of multiple medications by a patient which can lead to potential risks such as drug interactions, side effects, challenges in medication management

Documenting immunizations

Childhood vaccinations

adult vaccinations

list with type and dates

Documenting preventative screenings

Pap smears

Colonoscopy

Mammograms

DEXA scans

Purpose and frequency of pap smears

P: cervical cancer screening in women

F: starts at 21 and continues at regular intervals

Purpose and frequency of a Colonoscopy

P: screening for colorectal cancer

F: typically starting at age 50 with f/u based on findings

Purpose and frequency of mammograms

P: breast cancer screening in women

F: starts at 40 and recommended f/u based on doctor recommendation

Purpose and frequency of DEXA scan

P: screening for osteoporosis especially in postmenopausal women and older adults

F: recommendations vary often starting around age 65 for women

What is a pedigree

an analysis chart and is a tool to study the inheritance of genes and the family history of traits and disorders

Define proband

patient being interviewed

Important things to ask for in family history

family members( 3 generations)

ages of family members

ages of time of death

significant medical problems within family

consanguinity

ethnicity of grandparents

associated review of family

Red flags in family history interviewing

known genetic disorder

disease that may be genetic

multiple miscarriages

birth defects +/- intellectual disability

ethnic background

consanguinity

Why is it important to take a social history

to identify factors outside of past or current medical conditions that may influence the patients overall health or behaviors that create risk factors for specific conditions

What are the components of social history

Basic demographics

Religious and cultural history

spirituality

diet

exercise/activity

substance use

home life, upbringing

occupation

travel history

exposures

sexual history

recreation and hobbies

safety

Education level

highest level of education

this can influence literacy, understanding of medical information, ability to navigate health care system

Level of literacy

ability to read, write and comprehend information

essential for understanding health-related instructions, medications labels, and educational materials

Primary language

the language an individual is most proficient in or uses daily

communication in patients primary language is crucial for understanding instructions

Obstacles in communication

any challenges or barriers that may hinder effective communications

Religion and cultural beliefs

religion and cultural beliefs may impact patients overall health and beliefs related to illness, family, symbols, nutrition, social event, taboos

What to include when asking a patient about their dit?

nutritional intake

caffeine intake

food allergies/ restrictions

what they consumed in the last 24 hours

What is important in documenting daily activity/ exercise?

level of activity, type, frequency, duration, even sedentary lifestyle

what is included in the substance abuse section of your note?

include tobacco, alcohol, drugs, quantity, and how long this occurred

what is needed for smoking history and how is it calculated

pack years = duration of smoking in years x # of packs of cigarettes smoked/day

What do you include in social support system/ home life section of the note?

who lives with patient

any children

married/widowed/divorced

do they feel safe at home

what type of home do they live in

any barriers to healthcare

What should be included in occupational history section of a note?

current or past employment hazzards

any major stressors associated with their work

any military service

What should be included in the travel history section of a note?

list of areas traveled to or worked in

domestic travel or international travel

recent or remote

Why is it important to ask patients about sexual history in a comprehensive exam?

to determine risk of STIs or the source of potentially related complaints

What questions to ask patient as part of the safety section in a note?

helmet use?

sunscreen use?

seatbelt use?

injury?

firearm owner and if yes where is it stored?

where do you keep your medications?

any dangerous activities?

where do you keep your cleaning materials?

What ate the 4 factors that might yield an unreliable social history?

1. it can be awkward

2.shame/ fear

3. questions too personal

4. communication barriers

Why is understanding a patients social history important for their overall health status?

it provides insights into potential risk factors and support systems

3 multiple choice options

Which patient factor might suggest that their social history may be unreliable?

the patient avoids eye contact and is hesitant to answer questions

3 multiple choice options

Which approach demonstrates effective communication and professionalism when obtaining a sexual history?

using clear and non-judgmental language

3 multiple choice options

Which interviewing technique is most effective in eliciting a complete social history from a patient?

listening actively and allowing the patient to speak freely

3 multiple choice options

What is a soap note and what does it stand for

Subjective

Objective

Assessment

Plan

Subjective includes:

details about the patient's narrative. it may also include their perspective on their past and current health and concerns

Objective includes:

physical examination findings, vital signs, laboratory results, diagnostic tests, and any other objective data

Assessment includes:

the health care providers professional judgment about the patients condition and diagnoses, including any differential diagnoses

Plan includes:

recommended treatments, prescriptions, diagnostic tests, therapeutic interventions, lifestyle modifications, and any instructions for follow-up care

What is a Ddx and why is it important when conducting an assessment of a patient?

it is a list of differential diagnoses that could be the reason for the patient's symptoms. develop the ddx before beginning the interview and narrow your list as you go on with the visit.