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CS Exam 1
Terms in this set (22)
Identify the structure and timeline of the clinical encounter
o Initiating the encounter
o Gathering information
o Performing the physical examination
o Explaining and planning
o Closing the encounter
Identify the components of initiating the encounter: "SARGIS"
o Set: Set the stage
o Adjust: Adjust the environment
o Review: Review the clinical record
o Greet: Greet the patient and establish initial rapport
o Identify: Identify patient title, name, and preferred gender pronoun(s)
o Set: Set your agenda
Identify the importance and key elements of good communication and potential consequences of poor communication
--Rapport and relationships
--Patient compliance (Prevention = Best medication via patient education)
--Better follow up
--Litigation (everything written on chart may be held liable)
Determine characteristics of good communication: "Tools to Use"
o Active listening
o Guided questioning
o Empathic responses
o Empowering the patient
Active Listening - Their Turn
o Being present, free from distractions
o See the patient
o Verbal and nonverbal response
o Listen for what isn't being said by the patient
Active Listening - Your Turn
o Encouraging - "Thank you for sharing this with me. Can you tell me more?"
o Clarifying - "Can you tell me more about how this belly pain feels to you?"
o Restating - "Am I correct in saying you have had this belly pain for 3 days but it worsened this morning?"
o Reflecting - "It seems that this leg pain is causing a lot of stress for you and your family. Is that accurate?"
o Moving from open-ended to focused questions
o Use questions that elicit a graded response
o Asking a series of questions, one at a time
o Clarifying what the patient means
o Encouraging with continuers
o Using echoing/repetition
o Offering multiple choice answers - when and how?
Open-ended vs focused questions
Open-Ended: requires more than a "yes" or "no" answer
"Can you tell me what brings you in today?"
"How is your knee feeling today?"
"Did you take your medication today?
"Do you have chest pain?"
Use questions that elicit a graded response
--Questions that lead to an answer that requires a thoughtful response
--"How do you do climbing a flight of steps? INSTEAD OF "Do your legs feel weak when going down the stairs
Why would you limit the number of questions? Why not a series of questions vs one at time?
Too many questions = poor accuracy
Offering Multiple Choice
--Always allow the patient to answer an open-ended version of the questions FIRST!
--Be careful not to "lead" the patient!
--Best if patient is having difficulty with description
--"Can you describe your pain?"
· Sharp, stabbing?
· Dull, achy?
· Electric shock?
Encouraging with continuers
--Asking or prompting the patient to elaborate further or continue
· Nod of the head, lean forward, make eye contact
· "Mhm" or "Go on" or "I'm listening"
--Especially useful when documenting using HER
--Taking the last word(s) of the patient and repeat them
--Prompts the patient to elaborate with your interjecting bias
· Patient: Yeah, I blew my nose and it was green.
· You: Green?
· Patient: Yes, and it had a little blood in it too.
· You: Mhm
o To express empathy, you must FIRST recognize the patient's feelings
o THEN actively move toward and elicit emotional content
--"How do you feel about that?"
--"That seems to trouble you, can you say more?"
o Don't make assumptions, their response may surprise you.
--"I cannot imagine how hard this must be for you"
o For a response to be empathic, it must convey that you feel what the patient is feeling
o Give the patient a quick recap of their HPI
o Demonstrate that you have been listening
o Allows for any correction
o Patient may remember another piece of the history (often happens)
o Can help transition into the next part of the exam/history
o Help ease the patient, clear expectations
o Tell the patient when you are changing directions
o Prepare them for what's next
--"Now I'd like to ask some questions about your past health"
--"Before we move on to reviewing all your medications, was there anything else about past health problems?"
o Idea that the patient sees you as continuing their care
--Ask if patient agrees/able to follow the plan - ask the pt, any potential barriers?
--"How does that sound?"
--"Any areas that you are concerned with?"
o If not within your scope of practice, refer them to the appropriate provider
o Similar to encouraging technique of active listening
o Affirmation helps build rapport, reassure patient
o Patient/family: I'm sorry to bother you, I know you are really busy.
o You: Don't worry, you are the reason why I came to work today. How can I help?
Empowering the Patient
o Empower patients to ask questions, express their concerns and probe your recommendations
Why is empowering the patient important?
Patients will be more likely to adopt your advice, make lifestyle changes, or take meds as prescribed
How do you empower patients?
o Evoke the patient's perspective - "do you understand what I am saying?"
o Convey interest in the person, not just the problem - do NOT miss seeing the patient, see the patient as a WHOLE
o Follow the patient's leads - as they move from one topic to another
o Elicit and validate emotional content
o Share info with the patient esp at transition points during the visit
o Make your clinical reasoning transparent to the patient - "this is what I believe is to be happening..." speaking in layman's terms
o Reveal the limits of your knowledge - "Let me refer you to a specialist so we can check A, B, C"
o Initial response, "Don't worry. Everything is going to be alright."
o The FIRST step to effective reassurance is: simply identifying and acknowledging the patient's feelings
o Say what you see - "You seem upset today" --> Followed by "Am I right?"
o When the patient feels that problems have been fully understood and are being addressed, reassurance is more appropriate
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