PA Seminar

Created by

Hanna Abraham

Cards (48)

Introduction to the patient encounter
Three functions
Building an effective provider – patient relationship
Assessing the patient's problems
Managing the patient's problems
Building an effective Relationship
Foundation
Emotional aspect
Of health
Of illness
Family and personal dynamics
Involves patient and family members
Whole patient
Assessing the patient's problems
Patient history
Extremely valuable information
Gathering of data
Accuracy
Why are they here today
Prior relevant history
Time-efficiency
Managing the patient's problems
Patient education
Educate
Motivate
At the patient's level
How to start 
Dress
How do I introduce myself?
What do I call the patient?
What if the patient does not want to talk with a student?
What if the patient does not want to talk with a physician assistant?
Eye contact
Body posture
Tone of voice
Inflection
Space – Where is your chair in relation to the patient's?
Noise
Temperature
Privacy
Space
Time
Physical Barriers 
Provider
Lack of or deterioration in communication skills
Non-disclosure
Discouragement of collaboration
Language barrier
Cultural issues
Patient
Resistance
Fear/Mistrust
Health literacy
Classic (archaic) training in the medical model suppressed empathy
Studies demonstrate that students (PA, medical, nursing) place a higher emphasis on good communication than do practicing clinicians
Individual patient-provider communication skills tend to wane as time goes on
Building Rapport 
Non-verbal skills
Empathy
Partnership
Respect
Support
Non-verbal skills 
Eye contact
Posture
Facial expression
Rate and tone of speech
Touch
Empathy 
"I can see that you are upset"
"Anyone in your situation would feel this way"
Partnership 
Provider is not a dictator
Patient should have an active role in their care
Very different relationship than 50 years ago
Respect & Support 
Encouragement
Something they are doing well
How can I help
5 Vowels of Interviewing
Audition
Evaluation
Inquiry
Observation
Understanding
Inviting the Patient's story
1. Focus on patients agenda
2. Open ended questioning
3. Adaptive questioning
4. Active listening
5. Facilitation
6. Clarification
7. Summarizing/Echoing
8. What else
Characteristics of a good interviewer
Non-judgmental approach
Open, inviting body language
Maintain professionalism at all times
Poses open-ended questions
Good listener
Uses laymen's terms
Chief complaint & history of Present illness
Establishes the problem and how long it has been going on for
Opening 
Introduction
Your role in their care
Their name
How they like to be addressed
Consent
Initial rapport
Assessing their mood, status, etc.
How do you feel
Chief complaint 
2 functions: Establish problem, Establish how long it has been going on for
Respond to and validate their emotions
How does this problem make them feel
In their words
Facilitation: Tell me more
Checking: Makes sure you have facts straight
Anything else
History of present illness
Exploration
Thread of events
Timeline
OPQRSTU 
O = Onset
P = Palliating/Provoking factors
Q = Quality
R = Radiation/Reoccurrence
S = Severity (0-10 scale)
T = Timing
U = Usual activity
Associated Symptoms 
Sometimes referred to as positives (+'s) and negatives (-'s)
General: Fever, chest pain, shortness of breath, weight loss
System based: System above and system below presenting complaint
Components of the past medical history
Illnesses
Hospitalizations
Surgeries
Medications
Injuries
Allergies
Pregnancies
Exposures
Health maintenance
Transition 
1. Let patient know you are moving on from current complaint
2. Closed-ended questions
3. Develop a series of questions
Illnesses to include 
Heart disease
Diabetes
High blood pressure
Kidney disease
Ulcers
Lung problems
Psychiatric problems
Injuries 
1. What happened
2. Treatment
3. Residual deficits
Hospitalizations 
1. When
2. How long
3. What condition
4. What hospital
5. Complications
Surgeries 
1. When
2. Type
3. Hospital
4. Complications
Medications 
1. Name
2. Dose, how often
3. Why
4. Vitamins/over the counter remedies
5. Compliance
Allergies 
1. Allergies to medications - What type of reaction, when
2. Allergies to food - What happened, when
3. Allergies to environment - What happens
Pregnancies 
1. Prior pregnancies - How many
2. Deliveries
3. Abortions (spontaneous and elective)
4. Complications
Exposures 
Chemicals
Dusts
Fumes
Health Maintenance 
Check-ups
Screening
Immunizations
Injury prevention
Exercise
Family History 
Current age (or age of death) of parents and grandparents
Illnesses in parents and grandparents
Age and health status of siblings and children
Any illnesses that run in your family
Social History 
Level of education
Occupation
Family dynamic (single, married, divorced, widowed, children)
Living arrangements
Stresses – financial, emotional
Leisure activities
Sexual history
Identity/preference/orientation
Unprotected sexual relations
Number of partners in last 6 months
Alcohol use/abuse
C A G E questions
Cigarette smoking - How many cigarettes/day x how many years
Recreational drug use
Prescriptive medications
Illicit drugs
The silent patient 
Difficult to get information needed
Does not have to be awkward
Pay attention to non-verbal cues
The talkative patient 
Difficult to get information needed
Attempt to focus on what seems most important
Make a plan
The anxious patient 
Anxiety about hospitals/healthcare providers in general
Anxiety about test results
Anxiety about medical condition
The crying patient 
Difficult to get information needed
Pause, reflect
Empathy
Offer tissue