1.Medical interview – Establishing contact and collecting information: –
In Medical Interview, When you meet your patient for the first time then you should first introduce yourself and ask his / her name very politely and great very nicely. make him comfortable making eye contact. by this, you can establish contact collecting information by asking him an open question,1-2 close questions, by making him comfortable eye contact.
Mental rehearsal is a useful way of preparing for stressful tasks. This can be accomplished by reviewing the plan for telling the patient and how one will respond to patients’ emotional reactions or difficult questions. As the messenger of bad news, one should expect to have negative feelings and to feel frustration or responsibility. it is helpful to be reminded that, although bad news may be very sad for the patients, the information may be important in allowing them to plan for the future.
Sometimes the physical setting causes interviews about sensitive topics to flounder. Unless there is a semblance of privacy and the setting is conducive to undistracted and focused discussion, the goals of the interview may not be met.
Some helpful guidelines;-
Arrange for some privacy;- In Medical Interview, An interview room is ideal, but, if one is not available, draw the curtains around the patient’s bed. Have a tissue ready In case the patient becomes upset. Involve significant others. Most patients want to have someone else with them but this should be the patient’s choice. When there are many family members, ask the patient to choose one or two-family representatives.
Sit down;- Sitting down relaxes the patient and is also a sign that you will not rush. When you sit, try not to have barriers between you and the patient. If you have recently examined the patient, allow them to dress before the discussion.
After Medical Interview, Make a connection with the patient;- Maintaining eye contact may be uncomfortable but it is an important way of establishing rapport/relationship. Touching the patient on the arm or holding a hand (if the patient is comfortable with this) is another way to accomplish this.
Manage time constraints and interruptions. Inform the patient of any time constraints you may have or interruptions you expect. Set your pager on silent or ask a colleague to respond to your pages.
2.Medical interview – Types of questions, Interview management: –
there are mainly 3 types of questions
a) open question
b) close question
c) alternative question
Medical Interview managements: – firstly an interview room should be ideal .make a connection with the patients. maintain eye contact. You should establish a rapport/relationship. You should ask 3-5 open questions. when you check the body of the patient, before touch you should ask questions. you should inform the patient about the disease in understandable words that is not use medical terms. you should respect or understand the emotions of patients who have an open posture.
3.Medical interview, Empathy, and Active Listening Techniques: –
In Medical Interview, Addressing the Patient’s EMOTIONS with Empathic Responses;- Responding to the patient’s emotions is one of the most difficult challenges of breaking bad news. – Patients’ emotional reactions may vary from silence to disbelief, crying, denial, or anger.
When patients get bad news their emotional reaction is often an expression of shock, isolation, and grief. In this situation, the physician can offer support and solidarity to the patient by making an empathic response.
An empathic response consists of four steps in Medical Interview: –
First – observe for any emotion on the part of the patient. This may be tearfulness, a look of sadness, silence, or shock.
Second -identify the emotion experienced by the patient by naming it to oneself. If a patient appears sad but is silent, use open questions to query the patient as to what they are thinking or feeling.
Third – identify the reason for the emotion. This is usually connected to the bad news. However, if you are not sure, again, ask the patient.
Fourth – after you have given the patient a brief period of time to express his or her feelings, let the patient know that you have connected the emotion with the reason for the emotion by making a connecting statement. An example:
Doctor: I’m sorry to say that the x-ray shows that the chemotherapy doesn’t seem to be working [pause]. Unfortunately, the tumor has grown somewhat.
Patient: I’ve been afraid of this! [Cries].
4.Medical interview, Commenting and providing information during the interview:–
during the Medical Interview when you check the body of the patients you should ask questions. You should be providing information about his/her disease by using simple phrases/ understandable words.
5.Medical interview, Collection of feedback, summing up the results, completion of the interview: –
After a whole Medical Interview with the patients with you should collect feedback from your patients to repeats the main points .like – what you should do next in the future. SUMMARY Patients who have a clear plan for the future are less likely to feel anxious and uncertain. Before discussing a treatment plan, it is important to ask patients if they are ready at that time for such a discussion. Presenting treatment options to patients when they are available is not only a legal mandate in some cases, but it will establish the perception that the physician regards their wishes as important. Sharing responsibility for decision-making with the patient may also reduce any sense of failure on the part of the physician when treatment is not successful. Checking the patient’s misunderstanding of the discussion can prevent the documented tendency of patients to overestimate the efficacy or misunderstand the purpose of treatment.
In Medical Interview, Clinicians are often very uncomfortable when they must discuss prognosis and treatment options with the patient if the information is unfavorable. Based on our own observations and those of others, we believe that the discomfort is based on several concerns that physicians experience. These include uncertainty about the patient’s expectations, fear of destroying the patient’s hope, fear of their own inadequacy in the face of uncontrollable disease, not feeling prepared to manage the patient’s anticipated emotional reactions, and sometimes embarrassment at having previously painted too optimistic a picture for the patient.
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6.Interview with a difficult patient: –
In Medical Interview, there are mainly four types of difficult patient’s: –
a) dependent clingers – these are the patient who pours on the praise. they have finally found a doctor. who can help them? they flatter their physicians into providing special privileges, such as ACCESS BY PERSONAL PHONE, E-MAIL, PERMISION for after-hours communications. To avoid getting to the point where they dread any interaction with patients, physicians need to reestablish firm interpersonal boundaries. Follow up visit at regular intervals. Providing patients with written instructions between visits.
b) the entitled demander – these types of patients like to tell you what types of test to order and medication to prescribes and may threaten legal action if denied. Under this condition “to provide you with the best possible medical care, we must work together respectfully and collaboratively.
c) the manipulative help rejecting complainer – this type of patient drags the physician through an endless cycle of help-seeking and help to reject. No matter how upsetting this patient passive aggression maybe make it clear that you are genuinely on their side. And open to collaboration .then agree only to truly necessary interaction and treatment.
d) the self-destructive denier – this is the patient that knowingly continuous behavior that is dangerous to their health this daredevil patient. frequently feel hopeless and often suffer from and undiagnosed. The best way to ameliorate this issue is to concurrently care for the patient with mental health professionals.
7.Delivering bad news; –
In Medical Interview, warning the patient that bad news is coming may lessen the shock that can follow the disclosure of new and maybe facilitate information.
a)Build a relationship
c)Understand the patients perspective
d)Speak in the simple/plain language
e)Remain available for more interaction.
f)Schedule enough time for your means and their questions.