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Unformatted text preview: ed by the patient
and assess them accurately, and you feed back that awareness at the same level of
4. Additive: You recognize not only what the patient expresses openly but also what he or
s he feels but does not express. Coulehan: p. 38 - 4 5.
chief complaint Main reason why the patient sought medical help. It is usually recorded verbatim in the
patient's own words.
ostensible reason for coming vs. Iatrotropic stimulus, or actual reason for coming, may be different from the ostensible chief
actual reason for coming
3 reasons why patients seek care 1. Symptoms of the illness may increase to the point that they become unbearable and the
at a particular time
person simply realizes he or she needs medical help.
2. Anxiety about the meaning of the symptoms may reach the point where the person seeks
3. The symptom in the chief complaint is sometimes a "ticket of admission" to the
physician's office or ER. The actual problem may be entirely different.
5 ways to set the stage and get
1. Establish a sense of privacy for the interview.
2. Introduce yourself appropriately and establish a contract.
3. Maintain an attentive body position.
4. Take notes, but maintain enough eye contact so as not to lose the patient.
5. Use language the patient can understand.
Coulehan: p. 170 - 181
4 ways to achieve efficiency and 1. Solicit the patient's agenda.
focus in the office setting
2. Negotiate priorities.
3. Orient the patient to the flow of the encounter.
4. Maximize patient understanding.
6 ways to maximize patient
1. Use plain English, rather than medical jargon.
2. Use concrete and specific language; avoid vague reference.
3. State the important message first, then use repetition to reinforce it.
4. Ask the patient to restate the message.
5. Give corrective feedback.
6. Provide opportunities for questions.
Handout: Beginning the Interview:
Basic Facilitating Skills
First 4 st ages of t he int erview. 1. Setting the stage
2. Agenda setting
3. Open-ended inquiry (non-focusing then focused interviewing)
skills that enhance rapport. Whereas verbal behavior can be deceptive and misleading, nonverbal behavior speaks the
t ruth. Nonverbal communcation is redundant, ambiguous, and discrepant. Two concepts
t hat can facilitate your response to a patient's emotional distress are reflection (describing
t he emotional expressed) and l egitimation (confirming that the emotion is understood and
accepted). Handout: Building a History
Rather than Taking One
3 communication skills that
1. Question-asking mindfulness: The ability of the physician to observe not only the
physicians might use to facilitate patient during the medical interview, but himself/herself as well.
cooperative history building and 2. Organizational Multitasking: History building requires the physician to listen to a
the patient's telling of his or her
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- Fall '12