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31 Cards in this Set

  • Front
  • Back
RAPPORT
spontaneous, conscious feeling of harmonious responsiveness that promotes development of constructive therapeutic relationship.
MODELS OF INTERACTION
•Paternalistic
•Informative
•Interpretive
•Deliberative
BARRIERS TO RAPPORT
•Remaining cold, aloof, “technical”
•Overplaying the power differential
•Being defensive or suspicious of patients in general (i.e. lawsuits)
•Making the patient feel rushed – “next!”
•Dismissing their insights or observations
•Not answering questions
•Not apologizing & explaining a long wait
Establishing rapport requires physician to understand the individual’s:
- psychosocial & economic influences
- mental status & attitude towards being ill
6 Strategies for Developing Rapport
•Put patient and interviewer at ease.
•Find patient’s pain and express compassion.
•Evaluate patient’s insight & become an ally
•Show expertise
•Establish authority as physician
•Balance roles of listener, expert and authority
What is the Power Differential?
•Physicians are powerful
•Patients must trust dr.'s knowledge & power to get better
FIVE STAGES OF PATIENT ROLE
•Experience symptoms- “Something is wrong with me.”
•Acknowledge sick role- “I am sick and need help.”
•Seek professional help- enter system
•Allow dependency - Transfer control to doctor and follow treatment plan
•Recover/Rehabilitate - Give up pt. role
FIVE STAGES OF PATIENT ROLE will be influenced by:
•Personality
•Cultural beliefs
•Societal influences
•family Influences
How are PATIENTs EMPOWERed by RELATIONSHIP-CENTERED CARE?
•to be a partner in own diagnosis, treatment & cure
•trust & collaboration between doctor & patient
•patient will be forthcoming about symptoms & possible causes
•patient will understand own illness, its causes & possible treatments
•a frank understanding of disease course & prognosis
WHAT BUILDS A STRONG DOCTOR-PATIENT RELATIONSHIP?
when patient believes the dr. listened to & understood the description of the problem &
both agree on the nature of the problem
3 Functions of the Medical Interview
1. Determine nature of problem.
2. Develop & maintain therapeutic relationship.
3. Communicate info & implement treatment plan.
What is the objective of determining the nature of the problem?

Obj: to enable the MD to establish dx
to enable dr. to establish dx
What skills are needed to determine the nature of the problem?
1) knowledge base of diseases, disorders from multiple conceptual domains
2) ability to elicit data, encourage pt. to tell their story
3) ability to perceive data from multiple sources at multiple levels
4) hypotheses generation and testing
5) develop therapeutic relationship
What is the objective of developing and maintaining a therapeutic relationship?
1. pt. willingly provides information,
2. relief from distress,
3. Pt./dr. satisfaction
What skills are needed to develop and maintain a therapeutic relationship?
1) define nature of relationship
2) allow pt. to tell story
3) hearing, bearing, tolerating pt.’s expression of painful feelings
4) appropriate and genuine interest, empathy, support
5) attend to pt. embarrassment, shame, humiliation
6) elicit pt.’s perspective
7) determine the nature of problem
8) communicate information & recommend tx.
What is the objective of communicating information and implementing a treatment plan?
Pt. understanding of illness, procedures, tx possibilities, &
consensus about them,
informed consent,
improve coping mechanisms & lifestyle changes
What skills are needed to communicate info & implement a treatment plan?
1) determining nature of problem
2) developing therapeutic relationship
3) est. pt./dr. perspectives, education, clinical negotiation
How does a PSYCHIATRIC INTERVIEW differ from a MED-SURG INTERVIEW?
•Stigma
•Communication may be difficult (ex. cognitive disorder)
•May need to obtain info from others
•Increased emphasis on observations of behavior
What are Specific interview Techniques?
–Reflection
–Facilitation
–Confrontational
–Clarification
–Interpretation
–Summation
–Positive Reinforcement w/ Reassurance
Reflection
-Specific interview Technique
-repeating/paraphrasing what patient said, in supportive manner
•Assures that you (dr.) heard correctly
•Empathy- you are listening & concerned
•Example: “The pain started 5 days ago?”
Facilitation
-Specific interview Technique
•Uh-huh syndrome
–Be careful with this one
–May become unnecessary habit
–Example: “Tell me more about that”
Confrontational
•Substance Abuse - required for treatment to work
•Example: “You say you feel fine, but you look as if you’re having trouble breathing”
Clarification
•Just checking on data
•Works well when using Summation
Interpretation
•Making a connection for patient that s/he was not aware of at the time.
Summation
•Briefly summarize
•Demonstrates to patient you fully understand
•Example: “Let me review what you’ve told me to this point. Your back started hurting 2 days ago when you picked up the laundry basket. The pain is in your lower back, it hasn’t responded to over-the-counter medications, and it has been getting worse.”
Positive Reinforcement with Reassurance
•Provides hope for the patient
•Vital for successful therapy
What are IMPORTANT ISSUES in interviewing?
-Time Management
–Arrangement of office
–Taking notes
There is a higher degree of non-compliance with:
•Patients who are asymptomatic
•Psychiatric patients
Define Compliance
degree to which a patient carries out the clinical recommendations of the treating physician.
How many pts generally comply w/ tx?
In general:
•1/3 of all patients comply with tx
•1/3 sometimes comply with certain aspects of tx
•1/3 never comply
How to increase compliance?
•Increases w/ explanation, non-punitive attitude, & emphasis on value of treatment
•Dr.-Pt relationship is key