Techniques as Tools Part 3 Becoming More PatientCentered

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Techniques as ToolsPart 3Becoming More
Patient-Centered

• The Practice of Medicine
• Christine M. Peterson, M.D.

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Functions of the Medical Interview

• Gather data and understand
• Develop rapport and respond to emotions
• Educate and motivate
• Begin both diagnostic and healing processes

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Techniques Are Not Results

• The true endpoint of your use of techniques is
  the patients performance in the interview.
• Complete (facts, concerns requests, context)
• Truthful (facts and emotions)

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History of Present Illness O-P-Q-R-S-T
questions

• Onset and circumstances of Occurrence
• Provocative and Palliative factors
• Quality and/or Quantity of symptom
• Region of body and Radiation to other areas
• Severity of symptom (0 to 10 scale, if
  applicable) and associated Symptoms
• Time (duration) and Temporal associations

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• Video 8 doc.comGather Information

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Empathy

• a cognitive attribute that involves an ability
  to understand the patients inner experiences and
  perspective and a capability to communicate this
  understanding
• Note the patients emotions are not experienced
  by the physician

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Process of Empathy

• Four stages
• Identification
• Incorporation
• Reverberation
• Detachment

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Process of Empathy

• Identification
• Comprehend feelings and situation
• Incorporation
• Allow patients experience to penetrate awareness

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Process of Empathy

• Reverberation
• Physicians knowledge of patient interacts with
  physicians past experience
• Detachment
• Physician returns to present frame of reference

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Process of Empathy

• Patient may feel blessed in my soul

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Skills that Convey Empathic Understanding

• (REALLY PREPARE for understanding)
• Reflection
• Legitimation
• Personal support
• Partnership
• Respect

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• Video 6 doc.comBuild a Relationship

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The Patient-Centered Interview

• Focuses on the patients needs
• Activates the patient to play a larger role
• Is characterized by active listening
• Has a positive impact on patient outcome

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Evidence Expressing Concerns

• Patients who express more of their concerns are
  more satisfied and more likely to comply with
  medical regimens
• ? headaches, ? BP, ? days lost from work, ?
  functional limitations
• ? overall health ratings
• Same duration of interview!

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Expressing Concerns

• Not really actually means Im not going to
  tell you until I really know youll try to
  understand what Im saying.

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Evidence Specific Requests

• Often not obvious, not predictable
• When elicited ? more satisfaction whether or not
  granted
• Satisfaction more related to non-technical
  interventions than to technical ones

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Mc Whinneys Taxonomy of Medical Help-Seeking
Behavior

• Limits of tolerance for symptom
• Limits of tolerance for anxiety about symptom
• Problems of living presenting as symptoms
• Preventive/routine care
• Administrative reasons

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Evidence Patients Own Explanation of Illness
(Health Belief Model)

• Attending to patients beliefs ?
• better recall,
• more commitment to Rx plan
• Correlates with satisfaction

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Evidence Patients Expression of Feeling

• M.D.s who express awareness of patients concerns
  and feelings ? better outcome of care

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Evidence Giving Patients Information

• Strong positive correlation between patient
  satisfaction and perceived amount of information
  received
• Information-giving resulted in ? pain med
  requirement and ? length of stay

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Evidence Involving Patient in Developing
Treatment Plan

• Improved rate of kept follow-up appointments
• Improved functional capacity
• Improved physiologic parameters

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Communication Factors That Increase Patient
Adherence

• Information exchange and patient education
• Negotiation of mutual expectation
• Ensuring patient plays an active role in the
  interaction
• Positive affect from the clinician

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Communication Behaviors of No Claim Primary
Care Physicians

• Longer visits
• More orienting statements
• More humor, more laughter
• More facilitating comments

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Patient-Centered Interview

• Allows patients to express their concerns
• Seeks patients specific requests
• Elicits patients explanations of their illnesses
• Facilitates patients expression of feeling
• Gives patients information
• Involves patients in developing a plan for
  evaluation and treatment
• IMPROVES OUTCOME AND SATISFACTION.

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Practice

• Scenario 1
• Scenario 2

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• Video 9a doc.comUnderstand the Patient's
  Perspective