PBS 2.1.1
After 4 years of medical school, medical doctors complete specialized training in a field of interest
May specialize as surgeons, in certain body systems, or in specific diseases
Primary Care Physician - specialist trained to work in the front line of a healthcare system and provide care for any health problems patient might have
Usually first contact for person with basic health concern
Provide routine checkups and physicals, provide ongoing care to people with chronic illnesses - persistent and long-lasting illnesses
Medical Student - student enrolled at medical school, training to be a physician
Medical Technician - uses sophisticated equipment, has many different responsibilities
Some work directly with patients and others work in a lab
Medical Assistant - unlicensed caregiver who works primarily in doctors’ offices and clinics
Assist their medical director through wide variety of duties
Nurse - licensed healthcare professional, skilled in promoting and maintaining health
Patient Liaison - works with patients and families to address their needs and concerns
Intermediary between parents, their families, and hospital administration
Non-Physician Practitioner - health care provider who practices in collaboration with or under supervision of physician
Examples: Nurse practitioner, clinical nurse specialist, physician assistant
Pediatrician - specialist physician who provides medical care to infants, children, and adolescents
Genetic Counselors - advise families on their risk for inheriting or passing on certain diseases
Medical Interviews - conversation held with patients to record medical history
Doctors must skillfully converse with patient to get to heart of issue quickly, while also building relationship of trust and showing compassion
The following must be collected during the interview:
Medical History - record of information about patient’s past and current health, includes info about patient’s habits, lifestyle, and family health
Chief Complaint - patient’s description of what they feel is their main health problem
Physical Signs - pieces of evidence that indicate illness that can be observed externally - coughing, rashes, elevated temperature
Symptoms - subjective evidence of disease patient perceives - aches, nausea, fatigue
Allow health care provider to narrow down possible conditions that are affecting patient and run tests to make a diagnosis
Physical signs and subjective symptoms alone not enough evidence to provide diagnosis - identification of patient’s disease or injury
Must listen to patient - not just listen to words that are spoken, but look at subtle physical and visual cues
Patient might not be able to verbalize their condition or too shy/embarassed to directly state their issue
If cues are somewhat off - might point towards diagnosis
In the US, typical doctors visits are 15-20 minutes - important that doctor is efficient in throughtful in deciding what questions to ask
Accurate medical history can be more important than physical examination or results of laboratory tests
2/3 of diagnoses can be made using medical history alone
Also makes physical examination more productive, time-efficient - health care provider can focus on any clinical hypotheses generated during interview
Tips for Effective Conversations:
Establish rapport - sympathetic and positive relationship, & keep conversation friendly
Sit across patient and make eye contact, be ready to take brief, concise notes - avoid looking down at notes while asking questions or listening to answers
Take questions one step at a time, truly listen to patient - pay attention to facial expressions & gestures (important ones → clues for follow up questions)
Be respectful and open minded - don’t make prejudgments or assumptions about the patient
Components of a Medical History:
Current History - patient’s chief complaint and any other current health issues, symptoms, treatments/tests had to will be done related to these conditions
Includes nutrition, allergies, medication, health habits (exercise)
Previous History - includes information about past health issues, procedures, medications, vaccinations, and previous hospital stays
Social History - addresses aspects of patient’s life - living situation, occupation, school, travel, other activities with direct/indirect impact on health
Family History - medical information about patent’s close relatives (inherited health conditions)
Clinical Empathy - medical interview serves to build complete medical history, conversation should also be about establishing trust and ongoing relationship
Conversation not only about what doctor asks, but HOW they ask
Demeanor - outward behavior/bearing
Tact - discretion and sensitivity in dealing with others (choosing words carefully to not upset patient when they deliver bad news)
Empathy - ability to understand and share feelings of another person