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Art of interviewing In an interview, what factor do we need to consider? Social Economic Cultural How does the provider pick up on subtle ques? Shifts in body language in addition to spoken word Patients will tell you what is wrong with them if you ask the right questions Questions Open Ended OLDCARTS Don't use medical jargon Confrontation Watch for subtle ques "You look upset discussing _____, lets talk about it" Points out something striking about the patient's behavior or statement ○ Directs the patient's attention to something of which they may or may not be aware of ○ You look upset, you sound uncomfortable about that, Is there a reason you look away from me as you speak What does good communication improve? Health outcomes by resolving symptoms and reducing patient's psychogical distress and anxiety 85% of all malpractice lawsuits are based on poor communication skills What should we implement during an interview? ACTIVE LISTENING Watch their body language, tone, eye contact, speech and spoken word Understanding of what is being said, body language and other non verbal ques Symptom SUBJECTIVE ~What the patient feels ~Described by the patient Can be influenced by culture, intelligence and socioeconomic background Constitutional Symptom Fevers, Chills, Weight Gain, Weight Loss Effect all symptoms Sign OBJECTIVE What the observer finds on the assessment Crackles, dry skin, bruising What are the basic interviewing techniques? Questions Silence Facilitation Confrontation Interpretation Reflection Support Transitions Silence Silence is ok, but limit to 2 minutes or less If a patient is silent, you are silent Can restart the conversation with, "What are you thinking about?" Should never be used with the overtalkative patients ○ Can indicate interest and support ○ Don't allow more than 2 minutes of silence ○ Ok to ask: What are you thinking about? You were saying? These things are hard to think about Facilitation Keeps the conversation going "Tell me more about..." Encourages a patient to continue talking without controlling the direction of the conversation ○ Verbal and nonverbal communication that encourages the patient to keep talking ○ Go on, Tell me more, uh huh, And then Interpretation Based on inference "It sounds as if you are afraid...." Based on inference rather than observation ○ The provider interprets the patient's behavior, encouraging the patient to observe their own role in the problem. ○ You seem happy about that, Are you afraid you've done something wrong?, I wonder if your ____ is related to _____ Reflection Repeat part of the statement made by the patient Pt: "I haven't worked since 2016" APRN: "You haven't worked since 2016? Lets talk about that" A response that mirrors what the patient has just expressed ○ Patient: I am nervous about starting a new medication ■ Provider: Nervous about starting a new medication? Support Build a trusting relationship with the patient by using reassurance and empathy Shows an interest in or understanding of a patient ○ I understand ■ Reassurance ● A response that conveys to the patient that the interviewer understands what has been talked about ● That's great you were able to stop smoking, I am glad you came in today - we are going to help you ■ Empathy ● Response that recognizes a patient's feelings and does not criticize ● It's an understand, not an emotional state of sympathy ● I know it is not easy ______, I'm sure ______ has caused you a large amount of anxiety Transitions "Now I am going to ask you questions about..." Used as guides to allow the patient to better understand the logic of the interviewers questions in order to have a good flow to change the topic ○ I am now going to ask you questions about ______, Now let's talk about______ What does a past medical hx all include? General state of overall health Past Illnesses Hospitalizations Surgeries Prior injuries and accidents Allergies Current Medications Diet Sleep Patterns Immunizations Substance Abuse Complementary / Alternative Therapies What is sensitivity? How good a test is at identifying people who truly have the disease True Positive - Positive results are convincing RULE OUT = SnNout Sensitive test + Negative = disease OUT What is specificity How well a test does at correctly identifying people who are well True Negative - negative result is convincing RULE IN = SpPin Specific test + Positive = disease IN What is a functional capacity assessment? Asses geriatric patients abilities to perform activities of daily living (ADLs) -Self Care -Instrumental -Mobility -Timed Get Up and Go test Self Care ADLs Dressing Bathing Transferring from bed to chair Toileting Grooming Feeding oneself Instrumental ADLs Meal Preparation Managing Finances Use the phone Taking Meds Doing Housework Shopping Managing Transport Mobility ADLs Walking from room to room Climbing stairs Walking outdoors What is the timed get up and go test? Rise from chair, walk 10 feet, turn around, walk back to chair, turn and sit down Should be completed in 10 seconds or less If greater than 20 seconds, patient will need further evaluation What is the strongest predictor of future disability and death? Gait What should we be assessing in the elderly in relation to ADLs? # of falls in the last year Gender Identity One's internal sense of gender at a given time How a person feels and identifies themselves in terms of gender such as being a boy, girl or another gender Sexual Orientation The presence and/or object of a person's romantic, sexual, physical or spiritual attractions Who someone is attracted to or has romantic feeing towards ■ Same gender, different gender, more than one gender Alternative Medicine Systems Complete systems of health care that developed separately from Western/conventional medicine i. Traditional Chinese Medicine ii. Traditional Indigenous Healing Practices iii. Homeopathic Medicine Ayurvedic - translates to knowledge of life, origin = India Mind-Body Interventions Techniques that use the mind to help improve physical health and well-being Biofeedback Yoga / Meditation / Deep Breathing Prayer Tai Chi Biologically Based Therapies Natural substances or products from nature to improve health or treat illness Vitamins Herbal Products Probiotics Dietary Supplements Specialty Diets Manipulative and Body Physical movement, pressure, or hands-on techniques to help the body feel better or function better Chiropractic Osteopathy Reflexology / Massage Therapy Energy Therapies Energy fields in or around the body can be influenced to improve health or well-being Biofield therapy ~Intended to affect a patient's energy field for the purpose of healing by having a healer place their hands in or through them; the therapist's healing force restores the patient -Reiki -Therapeutic Touch Bioelectromagnetic based therapies ~Involve the unconventional use of electromagnetic fields. -Positioning external magnetic fields near or around the person, usually by placing magnets on the body, into clothing, or in mattresses Acupuncture -Traditional Chinese medicine in which thin needles are placed into the body to allow qi (energy) to flow unimpeded What is Yin & Yang? 2 opposite yet connected forces that exist in nature and the body They work together to maintain balance and harmony Yin Cooler Darker Quieter Slower Passive Associated with Rest Earth Moon Night Water Femininity Cold Yang Warmer Brighter Active Faster Masculinity Associated with Activity ■ Day, Heat, Light, Movement What is the goal of Yin & Yang? To Remain Healthy: ○ Maintaining a proper balance between yin and yang ○ Neither is considered completely good or bad ○ Both are necessary and work together What is the goal of Chinese Medicine? Not only cure disease, but keep people well Disease means failure in prevention of health care Health is a shared responsibility between the patient and provider Chinese medicine treats the patient as a whole rather than separate systems Preserving health, curing disease of mind, body and spirit The mind can help direct your body's energy toward healing and recovery Disharmony ■ Provides framework to help aid in healing ■ Ex: Patient doesn't catch the flu, develops disharmony. Abx, acupuncture or herbs can help to redevelop harmony What 2 techniques do the Chinese look at to diagnose? Tongue Pulse Assessment Tongue Assessment Believed to be a clear indicator of disharmony Color, Shape, Moisture, Coating, Thickness, Cracks & Texture of the tongue Pulse Assessment Disharmonies of the body have effects on the pulse ● Divided into 3 sections ○ Cun ■ Closest to the wrist ○ Guan ■ Second position ○ Chi ■ 3rd position, furthest from the wrist Left wrist (yin) ■ Heart, liver and kidney Right Wrist (yang) ■ Lungs, spleen and kidney Special Considerations for Peds: Head Palpable Anterior and Posterior Fontanelles Special Considerations for Peds: Eyes Inspecting for red reflex Special Considerations for Peds: Mouth Inspect for oral thrush and geographic tongue Special Considerations for Peds: Genitalia Inspect for hypospadias (males), diaper dermatitis, vaginal yeast Special Considerations for Peds: Hip Dystocia Perform Barlow and Ortolani Maneuvers Assess for normal newborn primitive reflexes Special Considerations for teens Assess Tanner Stages for breast tissue and genitals Can ask parents to step out of the room for the exam to allow you to ask further personal questions. The parents can refuse, although most are happy to step out If the parent does agree, do not continue with further examination until another medical witness is in the room with you Additional questions for teens include social history, illegal drug use, sexuality, suicide/depression screening and safety at home Billing and Coding Current Procedure Terminology (CPT) International Classification of Disease (ICD) Current Procedure Terminology (CPT) -Codes used to document many of the medical procedures performed in a medical office -Services and procedures provided 1. Evaluation and Management 2. Performance and Measurement 3.Emerging Medical Terminology International Classification of Disease (ICD) Explains the reason for the services ○ Classifies diseases and injuries and is used to track mortality and morbidity statistics ○ Assigned to identify the diagnosis, system, condition, problem, complaint or other reason for the encounter Bias An unfair or one sided opinion that can influence how someone thinks or acts Implicit Bias Unconscious attitudes or beliefs about people that can affect how we treat or judge them without realizing it Explicit Bias Conscious and intentional opinions to beliefs about a person or group that can lead to unfair treatment Race Groups of people based on physical traits, national origin and ancestry ■ Skin color, different features Ancestery ○ People, families and backgrounds one comes from ○ Genealogic history, understanding of one's genetic heritage Racial Bias An unfair or one sided opinion/judgement about someone based on their race Racism Treating someone unfairly, badly, negatively because of their race Scientific Racism The false idea that science proves some races are better, smarter or more capable than others Belief of biological evidence of racial inferiority/superiority Example: Black people are biologically different and inferior to white people Dominant Narrative The main or most widely accepted story or viewpoint about a topic, interests or ideas in a dominant social group Spirituality A person's sense of connection to something bigger than themselves, such as nature, a higher power, or their own inner beliefs and values. A person's search for meaning and purpose in life, including how they connect with themselves, others, nature, the present moment, and what they consider meaningful or sacred Religion A set of beliefs, practices, and traditions that help people understand life, spirituality, and their connection to a higher power or something sacred Gender Expression How a person shows or expresses their gender through things like clothing, hairstyle, behavior, voice or appearance What is included with Telehealth? Telemedicine Remote Patient Monitoring Videoconferencing mHealth eConsults Patient education / Coaching Continuing Education for the provider Telemedicine Patient care / Consultation Patient Monitoring Mentoring Digital Imaging What is included in Telehealth Etiquite? Environment Performance Privacy Telehealth - Environment Visual- Provider appearance Room appearance Lighting Picture quality Auditory - Provider noises, background noise, audio quality Telehealth - Performance Provider appearance and communication Use of equipment Provider Preparation Telehealth - Privacy Privacy of sites Equipment privacy settings Consents Mastered (1) You've been getting these terms right! Select this one What is the main purpose of an interview? Gather pertinent information -Patient's illness and how well they are adapting to said illness Goal is to gather important information regarding patient's illness/condition and how they are coping with it Not studied (2) You haven't studied these terms yet! Select these 2 What is included in Chinese medicine? What happens if there is a disharmony between Yin & Yang?

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