Random tips for completing the history assessment during the patient interview.

Interviewing

Apologize immediately when wait has been long. Sit down, don’t look at watch or act hurried.

Balance of empathy, listening, and structure.

Active listening, documenting during the interview.

Sit down, lean forward, state: “The nurse mentioned that you’re having this problem. Tell me the story.” Actively listen while giving patient one minute to speak.

“I’m sorry that I have to do this, but I have to make notes while we’re talking so that future providers know…”

Patients are the best experts on the terms of their own culture—ask them about it.  Variations include ethnicity, economic status, religion, age and gender.

If history is not taken well, data may be skewed or incomplete.

Don’t make assumptions about patients, such as “I’m sure you’re not a smoker.”

Be sure to ask patient if it is okay to speak with family member in room. Focus on patient, not family member. Be sure to have family member leave room temporarily at some point.

Warn patient when you’re about to ask of sensitive questions.

“That’s big news” is not negative or positive, it allows patient to process big information such as pregnancy, cancer.  No value is attached to the event/diagnosis/etc.

Don’t talk about your self. Don’t try to relate with life events such as deaths, etc.

Take time for self-reflection. What are you anxious about?

Review chart before going in room, establish if you have seen patient before.

Don’t introduce yourself and shake hands if you’ve met this patient before.

Be aware of how you dress; be professional.

Be aware of “failure of the therapeutic relationship.” Litigious, threatening, noncompliant people are examples of patients to avoid involvement with.

Avoid marginalizing patient based on narcotics, drug use, etc, etc.

If you must document on electronic record, have the patient sit next to you and explain “I must carefully document everything we discuss so that during future visits, we’re able to identify changes to body systems over time.”

 

Interview Environment

Place patient in front of wall to bounce sound off of—increases hearing.

Do not sit directly in front of patient as it is confrontational.

Have blankets in exam room if it is a cold environment.

 

Symptom Analysis

During the interview, you are completing a ROS; sometimes you have several complaints that are uncovered when the visit lasts for only 30 minutes.  To help address symptoms, use:

7 attributes of a symptom: location, quality, quantity or severity, timing, setting, remitting/exacerbating factors, and associated manifestation’s.

One way to differentiate viral from bacterial illness is to obtain CBC with differential.  If the lymphocyte count is elevated, the organism is likely viral.

 

Tavistock Principles

Rights: People have a right to health and health care.

Balance: Health of the population should be balanced with the health of individuals.

Comprehensiveness: Ease suffering, minimize disability, prevent disease, promote health.

Cooperation: Essential among patients, providers, and the system.

Improvement: Serious responsibility

Safety: Do no harm to patient or self.

Openness: Being open, honest, trustworthy is vital in health care. Don’t keep errors to yourself, may result in poor outcomes. (Lido & epi in Rocephin IM accident).

 

Sexuality

Must confront patient regarding sexual advances/jokes. Don’t assume that it’s okay, because a problem may come up again in the future.

Reflect on your own behavior.