6512 Midterm Exam
·Communication techniques used to obtain a patient's health history - answer Courtesy,
Comfort, Connection, Confirmation
Courtesy Communication Technique - answer• Knock before entering a room.
• Address, first, the patient formally (e.g., Miss, Ms., Mrs., Mr.) It is all right to shake
hands.
• Meet and acknowledge others in the room and establish their roles and degree of
participation.
• Learn their names.
• Ensure confidentiality.
• Be in the room, sitting, with no effort to reach too soon for the doorknob.
• If taking notes, take notes sparingly; note key words as reminders but do not let note-
taking distract from your observing and listening.
• If typing in the electronic medical record, type briefly and maintain eye contact with
patient, if possible.
• Respect the need for modesty.
• Allow the patient time to be dressed and comfortably settled after the examination.
Follow-up discussion with the patient still "on the table" is often discomfiting.
Comfort Communication Technique - answer• Ensure physical comfort for all, including
yourself.
• Try to have a minimum of furniture separating you and the patient.
• Maintain privacy, using available curtains and shades.
• Ensure a comfortable room temperature or provide a blanket—a cold room will make a
patient want to cover up.
• Ensure good lighting.
• Ensure necessary quiet. Turn off the television set.
• Try not to overtire the patient. It is not always necessary to do it all at one visit.
Confirmation Communication Technique - answer• Ask the patient to summarize the
discussion. There should be clear understanding and uncertainty should be eased.
• Allow the possibility of more discussion with another open-ended question: "Anything
else you want to bring up?"
• If there is a question that you cannot immediately answer, say so. Be sure to follow up
later if at all possible.
• If you seem to have made a mistake, make every effort to repair it. Candor is important
for development of a trusting partnership. Most patients respect it.
Connection Communication Technique - answer• Look at the patient; maintain good eye
contact if cultural practices allow.
• Watch your language. Avoid professional jargon. Do not patronize with what you say.
, • Do not dominate the discussion. Listen alertly. Let the patient order priorities if several
issues are raised.
• Do not accept a previous diagnosis as a chief concern. Do not too readily follow a
predetermined path.
• Find out whether the patient has turned from other healthcare providers to come to
you.
• Take the history and conduct the physical examination before you look at previous
studies or tests. Consider first what the patient has to say.
• Avoid leading or direct questions at first. Open-ended questions are better for starters.
Let specifics evolve from these.
• Avoid being judgmental.
• Respect silence. Pauses can be productive.
• Be flexible. Rigidity limits the potential of an interview.
• Assess the patient's potential as a partner.
• Seek clues to problems from the patient's verbal behaviors and body language (e.g.,
talking too fast or too little).
• Look for the hidden concerns underlying chief concerns.
• Never trivialize any finding or clue.
• Problems can have multiple causes. Do not leap to one cause too quickly.
• Define any concern completely: Where? How severe? How long? In what context?
What soothes or aggravates the problem?
SOAP Notes - answerS Subjective data—the information, including the absence or
presence of pertinent symptoms, that the patient tells you
O Objective data—your direct observations from what you see, hear, smell, and touch
and from diagnostic test results
A Assessment—your interpretations and conclusions, your rationale, the diagnostic
possibilities, and present and anticipated problems
P Plan—diagnostic testing, therapeutic modalities, need for consultants, and rationale
for these decisions
Ethical Considerations - answer• Autonomy: The patient's need for self-determination.
Autonomy suggests that choices exist, and a patient may choose between alternatives.
Uncertainty exists when the patient is a child or is cognitively impaired. Parents,
guardians, family, or other significant persons should then be included, and the
boundaries of that participation must be clearly set. In some cases, the boundaries are
established by an advance directive from the patient. Competency is not always easily
determined, and there may be disagreement. Both the mental status examination (see
Chapter 7) and consultation with individuals who know the person well can assist.
• Beneficence: Do good for the patient. This may be too eagerly pursued and may result
in a paternalism that might preclude autonomy of the patient. However, paternalism may
have some benefit when used with constraint and respect for autonomy.
• Nonmaleficence: Do no harm to the patient.
• Utilitarianism: Consider appropriate use of resources with concern for the greater good
of the larger community. Choose wisely.
·Communication techniques used to obtain a patient's health history - answer Courtesy,
Comfort, Connection, Confirmation
Courtesy Communication Technique - answer• Knock before entering a room.
• Address, first, the patient formally (e.g., Miss, Ms., Mrs., Mr.) It is all right to shake
hands.
• Meet and acknowledge others in the room and establish their roles and degree of
participation.
• Learn their names.
• Ensure confidentiality.
• Be in the room, sitting, with no effort to reach too soon for the doorknob.
• If taking notes, take notes sparingly; note key words as reminders but do not let note-
taking distract from your observing and listening.
• If typing in the electronic medical record, type briefly and maintain eye contact with
patient, if possible.
• Respect the need for modesty.
• Allow the patient time to be dressed and comfortably settled after the examination.
Follow-up discussion with the patient still "on the table" is often discomfiting.
Comfort Communication Technique - answer• Ensure physical comfort for all, including
yourself.
• Try to have a minimum of furniture separating you and the patient.
• Maintain privacy, using available curtains and shades.
• Ensure a comfortable room temperature or provide a blanket—a cold room will make a
patient want to cover up.
• Ensure good lighting.
• Ensure necessary quiet. Turn off the television set.
• Try not to overtire the patient. It is not always necessary to do it all at one visit.
Confirmation Communication Technique - answer• Ask the patient to summarize the
discussion. There should be clear understanding and uncertainty should be eased.
• Allow the possibility of more discussion with another open-ended question: "Anything
else you want to bring up?"
• If there is a question that you cannot immediately answer, say so. Be sure to follow up
later if at all possible.
• If you seem to have made a mistake, make every effort to repair it. Candor is important
for development of a trusting partnership. Most patients respect it.
Connection Communication Technique - answer• Look at the patient; maintain good eye
contact if cultural practices allow.
• Watch your language. Avoid professional jargon. Do not patronize with what you say.
, • Do not dominate the discussion. Listen alertly. Let the patient order priorities if several
issues are raised.
• Do not accept a previous diagnosis as a chief concern. Do not too readily follow a
predetermined path.
• Find out whether the patient has turned from other healthcare providers to come to
you.
• Take the history and conduct the physical examination before you look at previous
studies or tests. Consider first what the patient has to say.
• Avoid leading or direct questions at first. Open-ended questions are better for starters.
Let specifics evolve from these.
• Avoid being judgmental.
• Respect silence. Pauses can be productive.
• Be flexible. Rigidity limits the potential of an interview.
• Assess the patient's potential as a partner.
• Seek clues to problems from the patient's verbal behaviors and body language (e.g.,
talking too fast or too little).
• Look for the hidden concerns underlying chief concerns.
• Never trivialize any finding or clue.
• Problems can have multiple causes. Do not leap to one cause too quickly.
• Define any concern completely: Where? How severe? How long? In what context?
What soothes or aggravates the problem?
SOAP Notes - answerS Subjective data—the information, including the absence or
presence of pertinent symptoms, that the patient tells you
O Objective data—your direct observations from what you see, hear, smell, and touch
and from diagnostic test results
A Assessment—your interpretations and conclusions, your rationale, the diagnostic
possibilities, and present and anticipated problems
P Plan—diagnostic testing, therapeutic modalities, need for consultants, and rationale
for these decisions
Ethical Considerations - answer• Autonomy: The patient's need for self-determination.
Autonomy suggests that choices exist, and a patient may choose between alternatives.
Uncertainty exists when the patient is a child or is cognitively impaired. Parents,
guardians, family, or other significant persons should then be included, and the
boundaries of that participation must be clearly set. In some cases, the boundaries are
established by an advance directive from the patient. Competency is not always easily
determined, and there may be disagreement. Both the mental status examination (see
Chapter 7) and consultation with individuals who know the person well can assist.
• Beneficence: Do good for the patient. This may be too eagerly pursued and may result
in a paternalism that might preclude autonomy of the patient. However, paternalism may
have some benefit when used with constraint and respect for autonomy.
• Nonmaleficence: Do no harm to the patient.
• Utilitarianism: Consider appropriate use of resources with concern for the greater good
of the larger community. Choose wisely.
