Studies have shown that 60-80% of diagnosis are made on the medical history one takes from a patient, therefore it is a very important skill to perfect.
All of these skills interweave throughout the discussion of the presenting illness:
1. Eliciting the patient's narrative about the presenting problem
- Asking Open Questions: invite the patient to "open up" by saying, "Could you tell me about this pain from the beginning?" Open questions encourage the patient to express the presenting problem in their own words and bring in all the relevant factors from the patient's POW.
- Establish Motivation: identify the reason(s) for attenting today
- Facilitation techniques: "Uh-huh," nods, and paraphrasing info encourage patient's opening up.
- Responding to patient's emotional reactions: Either reflect on the patient's feelings as you have understood them ("You have been feeling sad since that event") or legitimize their feelinds ("most people worried when they have chest pain," or "It is natural to be concerned when your baby is ill").
- Summarizing and Feedback
- Probing to Completeness: "Is there anything else concerning you?"
2. The skill to assemble the informaiton obtained from a medical (disease) perspective
A neat trick to remember the diagnostic questions one can ask:
WWQQAAB:
- Where: The location and radiation of a symptom
- When: When it began, fluctuation over time, duration
- Quality: What it feels like
- Quantity: Intensity, extent, degree of disability
- Aggravating and Alleviating factors: what makes it worse/better
- Associated symptoms: other symptoms that have occurred with the main symptom
- Beleifs: the patient's beliefs about the symptoms
3. The skill to enable patients to talk about how the illness is impacting on their life circumstances.
The patient's perspective includes ideas, feelings, expectations and effects. In a patient centred approach to the medical interview it is just as important to explore this area as the Medical perspective in part 2 above.
Showing posts with label General Practice. Show all posts
Showing posts with label General Practice. Show all posts
1/11/07
1/2/07
The Medical Interview
The "medical interview" is the interaction a medical student or a doctor has with a patient. According to Skills for communicating with patients (1998) by Silverman, Kurtz and Draper, the medical interview can be separated into various phases:
1). Preparation
Prepare for the medical interview by cultivating full concentration. This can be done by putting aside the last task, attending to your personal needs and comfort (hunger, sleep, heat), reading any notes already available, and meet your patient with only him/her in your mind.
2). Introduction
Surprisingly, introductions are often skipped by doctors as they tend to attack the presenting complaint on its arrival. An introduction should include: name, position (if a medical student, then in what year? if a doctor, then what role in the treatment?), obtaining the patient's name, and then asking permission to conduct the medical interview (getting the patient's consent to be interviewed). "[smile, eye contact, and a friendly-ish greeting] Hello, I'm Doctor ______. Please come in and take a seat."
3). Consent
The medical interview can become a lot of just talking, but it's still important, especially when it comes to taking consent (asking the patient if he/she agrees to have hte interview). There is a misconception that a patient gives his/her consent to treatment as soon as he enters through the hospital doors, but that is not necessarily the case. "Hi, my name is ______ and I'm a second year medical student working with Doctor ______ who told me to take ten, fifteen, minutes talking to you before he joins us. Is that alright with you?"
4). Make Patient Comfortable
a). Privacy: draw curtains (around a ward) or go to a private consulting room
b). Verbal communication: don't talk loudly, angrily, hurriedly,
c). Non-verbal communication: easy eye contact (but not so much that the patient can't escape), sitting at equal footing with patient, not hiding behind a large desk or computer.
d). Patient's comfort: is the patient comfortable? fully dressed? in an appropriate environment? on a busy schedule?
5). Opening Question
The first question of the medical interview should be an open question, such as "How are you feeling today? What would you like to talk about today?"
6). Medical Interview
A helpful mnemonic to remember when conducting the medical interview is WWQQAAB:
W - What/Where
W - When
Q - Quality
Q - Quantity
A - Aggrevating/Alleviating factors
A - Associated symptoms
B - Beleifs
(More on this later)
7). Make No Assumptions
It is important not to make any assumptions. A high percentage of people that take alternative medicine (~75%) do not inform their doctors, often have more than one presenting complaint, the series in which patients present their problems is in no order (of importance), often the patient will talk more about the presenting complaint if allowed a moment of silence, do not interrupt the patient (this happens surprisingly frequently - doctors can usually only keep quite for an average of 18 seconds in the patient's opening complaint), encourage patients to elaborate or continue ("Yes, go on."), and double-check on all material before assuming ("Is there any other symptom you've been having?").
1). Preparation
Prepare for the medical interview by cultivating full concentration. This can be done by putting aside the last task, attending to your personal needs and comfort (hunger, sleep, heat), reading any notes already available, and meet your patient with only him/her in your mind.
2). Introduction
Surprisingly, introductions are often skipped by doctors as they tend to attack the presenting complaint on its arrival. An introduction should include: name, position (if a medical student, then in what year? if a doctor, then what role in the treatment?), obtaining the patient's name, and then asking permission to conduct the medical interview (getting the patient's consent to be interviewed). "[smile, eye contact, and a friendly-ish greeting] Hello, I'm Doctor ______. Please come in and take a seat."
3). Consent
The medical interview can become a lot of just talking, but it's still important, especially when it comes to taking consent (asking the patient if he/she agrees to have hte interview). There is a misconception that a patient gives his/her consent to treatment as soon as he enters through the hospital doors, but that is not necessarily the case. "Hi, my name is ______ and I'm a second year medical student working with Doctor ______ who told me to take ten, fifteen, minutes talking to you before he joins us. Is that alright with you?"
4). Make Patient Comfortable
a). Privacy: draw curtains (around a ward) or go to a private consulting room
b). Verbal communication: don't talk loudly, angrily, hurriedly,
c). Non-verbal communication: easy eye contact (but not so much that the patient can't escape), sitting at equal footing with patient, not hiding behind a large desk or computer.
d). Patient's comfort: is the patient comfortable? fully dressed? in an appropriate environment? on a busy schedule?
5). Opening Question
The first question of the medical interview should be an open question, such as "How are you feeling today? What would you like to talk about today?"
6). Medical Interview
A helpful mnemonic to remember when conducting the medical interview is WWQQAAB:
W - What/Where
W - When
Q - Quality
Q - Quantity
A - Aggrevating/Alleviating factors
A - Associated symptoms
B - Beleifs
7). Make No Assumptions
It is important not to make any assumptions. A high percentage of people that take alternative medicine (~75%) do not inform their doctors, often have more than one presenting complaint, the series in which patients present their problems is in no order (of importance), often the patient will talk more about the presenting complaint if allowed a moment of silence, do not interrupt the patient (this happens surprisingly frequently - doctors can usually only keep quite for an average of 18 seconds in the patient's opening complaint), encourage patients to elaborate or continue ("Yes, go on."), and double-check on all material before assuming ("Is there any other symptom you've been having?").
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