Term
| Which Doctor-Patient Communication Model is never used? |
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Definition
| Friendship Model (never accepted) |
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Term
WHO* definitions of sickness and Illness (World Heath Organization)
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Definition
Sickness is different from having a disease
Assuming the “sick role” - “being perceived as sick by others or feeling sick oneself.
The person in the sick role MUST
1. rely on experience or seek professional assistance to get better”
2. adhere to culturally or professionally prescribed regimens that will help them get better.
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Term
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Definition
The active-passive model implies a patient's complete passivity and a physician's taking control.
The model is appropriate when patients are unconscious, immobilized, or delirious.(Incompetent)
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Term
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Definition
The physician's dominance is assumed and emphasized.
This model is often observed during a patient's recovery from surgery. (Delivering a child)
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Term
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Definition
The friendship model of the doctor–patient relationship is generally considered dysfunctional if not unethical.
The model often involves continuing the relationship rather than an appropriate ending and a blurring of boundaries between professionalism and intimacy.
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Term
| Mutual Participation Model |
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Definition
Giving Info, getting back info.
The mutual participation model implies equality between doctor and patient; both participants require and depend on each other's input.
It is especially obvious in the treatment of such chronic illnesses as renal failure and diabetes, in which a patient's knowledge and acceptance of treatment ramifications are critical to the success of the treatment.
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Term
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Definition
| Indicates that the physician is truly listening to the difficult subject that the patient is presenting. It allows the patient to continue talking as the patient is assured of a non-judgmental, caring and professional response. |
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Term
Addressing emotion
leads to
the strongest doctor-
patient relationships
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Definition
Emotions are a cue and a clue to the
patient’s well-being.
Even though most patients seek and
welcome emotional inquiry, they
may not spontaneously express
emotions.
They will offer clues though, that the physician must learn to identify and facilitate.
Histerical crying. Flight, Flee, Freeze. Best response: Interesting.
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Term
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Definition
| Lack of feelings of pleasure in acts that are normally pleasurable. |
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Term
Description of Successful Techniques
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Definition
1. Non-verbal techniques (Head nodding, leaning forward) and Verbal Cues (“Tell me more about that”).
2. Checking: Review or repetition to ensure accuracy of data being reported (“You think this started last Thursday?”)
3. Clarification: Asking the patient to clarify. Paraphrase what the patient said (“So your headaches are the worst when you wake up?”) or (“Give me an example of when you were the most anxious”).
4. Reflection: Paraphrasing what the patient has said, demonstrating that the physician has been listening. (“You’ve told me a lot of things. Let’s see if I’ve understood them all.”)
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Term
Description of Successful Techniques 2
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Definition
5. Interruption: Breaking the flow if the patient is rambling (may be due to nervousness or a bad habit). Achknowledge that you heard that.
6. Transition: A statement that links what the patient has been saying with a change in direction (“What you’ve been talking about reminds me to ask you…”)
7. Information sharing: Interpreting and explaining the problem. Used to clarify goals and establish shared expectations for outcomes.
8. Giving directions: Explanations of various tasks and responsibility for completing them should be clear, realistic and checked to ensure understanding.
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Term
Non-verbal
Communication and Cues
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Definition
A.Kinesics (body language, ie. Geatures, eye expression, Facial appearance).
B.Body Position (posture)
C.Touching (appropriate for most patients). Risk Runner
D.Paralanguage (everything but the content of language). “Great, I’m great”, really not. rapid and jerky voice, low-pitched voice, peculiar inflection, frequent sighs.
E.Spatial: vertical and horizontal distance to another, angles of facing each other, physical barriers in the space. far removed interaction; desk between persons
F.Eye Contact: continuous, broken.
G. General Appearance: Hygiene and grooming are very important. Provide diagnostic clues. Observing gait, facial features and expression, handshake, and quality of voice. Pay intense attention to the initial encounter.
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Term
What is the impact of illness on the person?
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Definition
What is the patient’s:
1. Level of alertness
2. Apparent state of health
3. Apparent state of distress
4. Emotional state
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Term
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Definition
| -Patient have the most power, can leave and not pay attention to your recommendations. |
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Term
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Definition
Doctor- centered style. It relies on closed questions designed to elicit yes or no answers. The doctor will tend to use a disease-centered model and be focused on reaching a diagnosis, rather than focus on the patients unique experience of illness.
Non-Adherence:
Physician does not take into account the patient’s experience or listen to the patient’s story
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Term
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Definition
1. Acknowledge Emotion
2. Encourage
3. Reassure
4. Non-Verbal Support
5. Minimizing Bias from Close-Ended Questions. Avoid “Leading” Questions: Suggesting a response by the way the question is asked.
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Term
Obstructive Interventions
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Definition
1. Compound Questions
2. Trapping Patient in their own words
3. Dismissal or Minimization
4. Premature Advice
5. Not Following the Patient’s Lead
6. Judgmental
7. Nonverbal Obstruction
8. Watch your why questions.
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Term
Common Interview Techniques
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Definition
1. Establish rapport as early in the interview as possible.
2. Determine the patient's chief concern / complaint in their own words.
3. Use the chief concern to develop a provisional (not final or fully worked out) differential diagnosis.
4. Rule the various diagnostic possibilities out or in by using focused and detailed questions.
5. Follow up on vague replies with enough persistence to accurately determine the answer to the question.
6. Use a mixture of open-ended and closed-ended questions. Start with open-ended questions
7. Give the patient a chance to ask questions at the end of the interview
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Term
| Common Interview Techniques (NEW) |
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Definition
1.Let the patient talk freely enough to observe how tightly the thoughts are connected.
2.Don't be afraid to ask about topics that you or the patient may find difficult or embarrassing. (sexual history).
3. Ask about suicidal thoughts.
4.Conclude the initial interview by conveying a sense of confidence and, if possible, of hope.
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Term
| Template for response to patient statements |
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Definition
1. Statements where the words are not clear
“not myself”, “not good”, “its weird”
Reflect back the statement: Do not assume you know what it means
2. Direct questions – about ethics, about treatment, about prognosis
Direct clear answers
3. Suicidal sounding statements
“I’m not going to take it anymore”, “I’m just going to have to end it”
Direct question: “ Are you thinking about killing yourself?’
4. Suicidal statement ( I have a duty to protect you from yourself. We’re going to help you).
“I am going to kill myself”
Question Plan – “How / When would you try to kill yourself?”
5. Emotional Statements (Usually to show how upset they are, 90% of the time their emotion changes).
“ I just hate doctors”
Reflect and verify the emotion – “You sound upset/angry”
“It’s just so hard to deal with this”
Validate the emotion – “I can see that this must be hard for you”
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Term
Strategy Review: Interviewing
Start with:
Hints:
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Definition
Start with:
“What brings you here today?”
“What would you like to discuss?”
“Where shall we start?”
Hints:
1. Silence is OK.
2. Limit self-revelations, be truthful.
3. Confrontations are OK if they are soft.
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Term
Addressing Non-Verbal Behaviors:
Soft confrontations |
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Definition
Mixed messages represent
conflict.
1.Indirectly acknowledge the disparity
“You say you are feeling great, but I get the feeling from you that it is not so great”
2.Address the incongruity directly
“While you were saying you felt great, you were shaking your head “no”, can you tell me about this?”
3.Soft confrontation on the use of a third person
“You say that this friend of yours is having problems,
but I get the feeling that you might be having these problems?”
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Term
Advanced Strategies
Getting information from patients |
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Definition
1. Avoid leading questions that suggest an answer.
2. Speak less and let the patient speak more.
3. Summarize the information the patient has provided, then CHECK with the patient.
4. Anticipate a patient’s unspoken questions and ask them.
5. Anticipate a patient’s unspoken fears and address them (Diabetics worry about their sex lives).
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Term
| Topics in Advanced Interviewing: Health Hazards |
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Definition
1. Addicting Substances: ask about duration, amount and type of addicting substance used. You will learn to use the CAGE.
2. Sexual Practices: sexual orientation, current sexual activity. Depression and anxiety must be inquired about.
3. Abuse: 1/5 of all women (20%) in a primary care population have reported some type of violence in their lifetime. Sexual, physical, verbal and psychological abuse must be explored.
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Term
Common Reasons for
Non-Compliance with Medication |
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Definition
1.Instructions are not clear
2.Side effects are intolerable
3.Psychiatric symptoms (mental) interfere with compliance (Mania, bipolar patient. Most stop their meds to be happy).
4.Patients like their symptoms (losing weight)
5.Patient’s life is disorganized and chaotic
6.Patient cannot afford the medications
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Term
| Impediments (Obstruction) to Communication |
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Definition
1. Sensory impairment
2. Language differences
3. Cognitive Differences: Differences between how the patient and physician conceptualize experiences and how they understand and explain the world.
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Term
More Impediments to Communication
-Age Effects
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Definition
1. Young children: more fearful, do not tolerate pain;
2. Adolescents: find threat in proposed changes and questions and do not tolerate discomfort;
3. Adults: find it difficult to tolerate recovery and absence from work;
4. Elderly: concerned about maintaining basic functioning.
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Term
More Impediments to Communication
-Gender Effects
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Definition
Males and Females have some classic style differences
1.Female patients ask more questions and receive more information.
2.Female physicians interrupt patients less.
3.Patients are more likely to initiate discussions on personal topics with female physicians.
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Term
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Definition
1.they express severity of symptoms correlated with an overtly diagnosable biological disorder
2.they are compliant and generally do not challenge the treatment,
3.they are emotionally controlled, and when they are grateful.
If these expectations are not met, physicians may blame patients and experience them as unlikable, untreatable, or bad.
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Term
| Working with Difficult Patients |
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Definition
1.Do not blame the patient for failure to comply
2.Do not blame the patient for difficult behaviors.
3.Set limits on inappropriate behavior by the patient, e.g. threatening or seductive behavior.
4.Do not abandon the patient (don’t turf patients).
5.Do not refer the patient to another health professional for anything other than a medical reason.
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Term
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Definition
1. Personality is a universal term to describe a person’s characteristic behavior in response to his or her inner and outer experiences.
2. Personality becomes disordered when it affects the functioning of the person in a maladaptive way.
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Term
Clusters of Personality Disorders
-Cluster A: “Odd, eccentric personality disorders” |
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Definition
1. Paranoid: Blames the physician for the illness. Is overly sensitive to a perceived lack of attention or caring from the physician.
2. Schizoid: Shows little emotional connection with the doctor.
3. Schizotypal: Behaves strangely and even more inappropriately when ill.
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Term
Clusters of Personality Disorders
-Cluster B: Flamboyant, Dramatic and Emotional Personality Disorders |
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Definition
1. Antisocial: Has no concern for others. Fails to learn from experience. Attempts to manipulate the doctor.
2. Borderline: May show brief periods of psychosis (any severe mental disorder in which contact with reality is highly distorted). Over-idealizes and the overreacts to perceived rejection by the doctor.
3. Histrionic (stage performance): Dramatic reporting of symptoms. Approaches the physician in an inappropriate sexual fashion during illness.
4. Narcissistic: Has a perfect self-image that is threatened by illness. Often demanding of perfect care when ill.
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Term
Clusters of Personality Disorders
-Cluster C: “Fearful, Anxious”
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Definition
1. Avoidant: Fears rejection by the doctor. Avoids tests and treatment.
2. Dependent: Has an excessive need to be cared for by others resulting in helplessness and the desire for attention from the physician during the illness.
3. Obsessive-Compulsive: Fears loss of control and may try to control the doctor during the illness. Follows the doctor’s orders to the exact letter.
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Term
| Addressing Predominantly Psychological Problems |
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Definition
1. Avoidance of psychological material is common among Residents. Unrecognized behaviors can interfere with new learning.
2. Avoiding common topics as disability, depression, or impending death can lead to many misdiagnoses.
3. Do not be reluctant to ask about any past physical and mental history.
4. Elicit (discuss) the symptoms of any psychological concern: "What are the symptoms, how long do they last, when did they start". |
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Term
Summary:
Responding to Your Patient (High Yield)
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Definition
1.The patient’s wishes, comfort and safety come first.
2.Always respond to questions asked.
3.Always respond to the emotional content expressed, express empathy and then give control.
4.Never lie, deceive or distort information.
5.Take time to listen and check for understanding.
6.Tell the patient everything with a comfortable flow, checking for readiness to hear information.
7.Make eye contact, when touching for a procedure tell them what you are doing.
8.Arrange seating for communication that is comfortable and egalitarian (equality of all people ).
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Term
A middle-aged woman seeks treatment for facial injuries. She starts to cry and says that her husband has been under a lot of stress lately. Her physician nods and says, “please go on.” The physician’s response is an example of which of the following interview techniques:
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Definition
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Term
A physician finds it difficult to keep the office visit of a patient on schedule because she rambles on about numerous things and tells stories that are unrelated to her medical complaint. She shows no signs of cognitive problems. Which of the following approaches could the physician use:
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Definition
a.Redirect the conversation with paraphrased statements
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