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Seidel n Ball n Dains n Flynn n Solomon n Stewart Effective Communication and Interviewing Skills Total running time: 19:43 Overview This program shows how to build an accurate and thorough history and develop a partnership with the patient. Because each patient has individual needs, it provides examples of effective communication and interviewing skills that may be used for different patients. After describing how to prepare the setting and yourself for the history, the first part of the program shows how one examiner uses effective communication skills to gather information from a patient with a headache. Then using the same examiner, patient, and symptom, this program demonstrates how ineffective communication skills uncover much less information. In the second part of the program, an examiner uses effective communication skills to obtain a history from a patient with abdominal pain. To contrast, the same examiner then uses ineffective communication skills with the same patient with dramatically different results. Learning Objectives After viewing the Effective Communication and Interviewing Skills program and reviewing the textbook 1 Mosby items and derived items © 2010, 2006, 2003, 1999, 1995, 1991, 1987 by Mosby, Inc. an affiliate of Elsevier Inc. Seidel_DVD16_2ndPgs.indd 1 1/28/10 10:47:11 AM chapter “Partnership with Patients: Building a History,” the learner should be able to: 1.Describe how to prepare the setting for effective communication. 2.Discuss ways to prepare yourself for effective communication. 3.Identify appropriate questions for different patients based on their chief complaint. 4.Explain ways to enhance patient responses. 5.List techniques for overcoming communication barriers. 6.Describe how to address issues that are sensitive for the patient. 7.Identify techniques to avoid when interviewing a patient and building a health history. Discussion Topics 1.Application of ethical principles to the health history interview 2.When to use different types of questions, such as open-ended and closed-ended (direct) questions 3.When to use different techniques to enhance patient responses, such as facilitation, reflection, and clarification 4.How to overcome barriers to communication 5.Methods for building the history in partnership with the patient 6.Tools and techniques for assessing alcohol and substance abuse, intimate partner violence, sexuality and safe sex practices, and other sensitive issues 7.Ways to adapt the interview for patients of different ages, frail patients, and those with physical or cognitive disabilities Program Outline I.Introduction II.Preparing for the interview A.Setting B.Structure of history C.Self 2 Effective Communication and Interviewing Skills Mosby items and derived items © 2010, 2006, 2003, 1999, 1995, 1991, 1987 by Mosby, Inc. an affiliate of Elsevier Inc. Seidel_DVD16_2ndPgs.indd 2 1/28/10 10:47:11 AM III.Building a history: Headache A.Effective communication, including use of OLD CARTS mnemonic and CAGE questionnaire B.Ineffective communication, including use of OLD CARTS mnemonic and CAGE questionnaire IV.Building a history: Abdominal pain A.Effective communication, including use of PQRST and HITS mnemonics B.Ineffective communication, including use of PQRST mnemonic and brief screening for domestic violence V.Summary Review Questions 1.To foster communication, the setting should have: a.Comfortable seats for you and the patient only. b.A lively, stimulating atmosphere with good lighting. c.A desk conveniently placed between you and the patient. d.A clock where you can see it, such as behind the patient. 2.Which item is not typically part of the health history? a.Family history b.Chief complaint c.Review of systems d.Record of job performance 3.When you first meet a patient named Arthur J. Chambers, how should you address him? a.Sir b.A.J. c.Arthur d.Mr. Chambers 4.To investigate a patient’s chief complaint, you should begin with which type of questions? a.Leading b.Clarifying c.Open-ended d.Closed-ended (direct) 3 Effective Communication and Interviewing Skills Mosby items and derived items © 2010, 2006, 2003, 1999, 1995, 1991, 1987 by Mosby, Inc. an affiliate of Elsevier Inc. Seidel_DVD16_2ndPgs.indd 3 1/28/10 10:47:11 AM 5.When enhancing patient responses, the examiner would demonstrate interpretation by saying: a.“I’m sorry to hear that.” b.“Can you tell me more about that?” c.“What do you mean when you say ‘disturbing’?” d.“The pain radiates from your stomach to your back.” 6.Which mnemonic helps guide the assessment of a symptom? a.HITS b.FICA c.TACE d.PQRST 7.In the CAGE questionnaire, the A indicates: a.Alcohol. b.Annoyed. c.Associated factors. d.Aggravating factors. 8.If you and your patient do not speak the same language, which of these people is the best choice for an interpreter? a.The patient’s spouse b.A friend of the patient c.A professional interpreter d.A blood relative of the patient 9.If a patient cries during the interview, what should you do? a.Leave the room. b.Pose leading questions. c.Move on to the next question. d.Offer tissues and a moment of silence. 10.In the HITS mnemonic, the S indicates: a.Stab. b.Scream. c.Severity. d.Screening. 4 Effective Communication and Interviewing Skills Mosby items and derived items © 2010, 2006, 2003, 1999, 1995, 1991, 1987 by Mosby, Inc. an affiliate of Elsevier Inc. Seidel_DVD16_2ndPgs.indd 4 1/28/10 10:47:11 AM 11.Which of the following is an example of clarification to enhance patient responses? a.“I understand how you feel.” b.“That behavior is unacceptable in this office.” c.“Of all these things, what concerns you the most?” d.“How have you been feeling since your last visit?” 12.If the patient becomes silent during the interview, what should you do? a.Talk about your own experiences. b.Change the subject to a neutral one. c.Probe to get at the root of the problem. d.Allow silence within reasonable bounds. Answers to Review Questions 1.d.To foster communication, the setting should have a clock where you can easily see it, such as behind the patient. It should also have comfortable seats for you, the patient, and anyone else present; a private, quiet atmosphere with good lighting; and minimal furniture between you and the patient. 2.d.The health history does not typically include the patient’s record of job performance, although it may include questions about the work history as it relates to health risks and occupational exposure. The health history includes identifiers, chief complaint, history of present illness or problem, past medical history, family history, personal and social history, and review of systems. 3.d.You should always formally address a patient, such as Mr. Chambers, when you first meet the patient. Then if the patient requests it, you may use a more casual form of address, such as A.J. or Arthur. Although Sir is a form of formal address, it is impersonal and not preferred. 5 Effective Communication and Interviewing Skills Mosby items and derived items © 2010, 2006, 2003, 1999, 1995, 1991, 1987 by Mosby, Inc. an affiliate of Elsevier Inc. Seidel_DVD16_2ndPgs.indd 5 1/28/10 10:47:11 AM 4.c.When investigating the chief complaint, begin with open-ended questions to encourage the patient to answer as fully as desired and without interruption. Avoid leading questions because they can limit information to only what the patient thinks you want to know. Use clarifying questions to find out what the patient means by a particular response. Use closed-ended (direct) questions later to obtain specific information. 5.d.Interpretation involves repeating what you have heard to confirm the patient’s meaning. “I’m sorry to hear that” is an example of empathizing. “Can you tell me more about that?” demonstrates facilitation. “What do you mean when you say ‘disturbing’?” uses clarification to enhance the patient’s response. 6.d.The PQRST and OLD CARTS mnemonics help guide the assessment of a present illness or symptom. HITS guides the assessment of domestic violence, FICA helps reveal spiritual concerns, and TACE aids in evaluating alcohol use. 7.b.In the CAGE questionnaire, C indicates cut down, A signifies annoyed, G indicates guilty, and E means eye-opener. Although the CAGE questionnaire assesses alcohol use, alcohol is not part of the mnemonic. Associated factors and aggravating factors are part of the OLD CARTS mnemonic. 8.c.When an interpreter is required, a professional interpreter is preferred to ensure confidentiality and accuracy. Using a family member or other person to interpret may be a barrier to candid conversation. It also breaches confidentiality and provides no assurance that the interpretation is correct. 6 Effective Communication and Interviewing Skills Mosby items and derived items © 2010, 2006, 2003, 1999, 1995, 1991, 1987 by Mosby, Inc. an affiliate of Elsevier Inc. Seidel_DVD16_2ndPgs.indd 6 1/28/10 10:47:11 AM 9.d.If crying occurs during the interview, you should be silent and let the moment pass at the patient’s pace. As needed, give permission and offer tissues. Such techniques as leaving the room, posing leading questions, and moving on to the next question do not display compassion, could prematurely stop the patient’s crying, and interfere with rapport-building. 10.b.In the HITS mnemonic for assessing domestic violence, H indicates hurt, I means insult, T signifies threaten, and S means scream. Severity is part of the PQRST and OLD CARTS mnemonics. Stab and screening are not part of this domestic violence assessment. 11.c.Clarification helps divulge what the patient means, such as with the question, “Of all these things, what concerns you the most?” “I understand how you feel” demonstrates empathy. “That behavior is unacceptable in this office” is an example of confrontation. “How have you been feeling since your last visit?” is an open-ended question that is best used at the beginning of the history. 12.d.If the patient becomes silent during the interview, respect the silence and be comfortable with it, but give it reasonable bounds. The other answer options are not appropriate responses to silence. If asked, you may talk about aspects of your experiences. You may later probe to investigate a problem, but you should not push too hard when the patient is silent. 7 Effective Communication and Interviewing Skills Mosby items and derived items © 2010, 2006, 2003, 1999, 1995, 1991, 1987 by Mosby, Inc. an affiliate of Elsevier Inc. Seidel_DVD16_2ndPgs.indd 7 1/28/10 10:47:11 AM Copyright © 2010, 2006, 1994 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Mosby items and derived items © 2010, 2006, 2003, 1999, 1995, 1991, 1987 by Mosby, Inc. an affiliate of Elsevier Inc. Seidel_DVD16_2ndPgs.indd 8 1/28/10 10:47:12 AM