The Medical Interview E-Book

Description

The Medical Interview by Drs. Steven A. Cole and Julian Bird equips you to communicate effectively with your patients so you can provide optimal care! This best-selling, widely adopted resource presents a practical, systematic approach to honing your basic interviewing skills and managing common challenging communicating situations. Its Three-Function Approach – "Build the Relationship," "Assess and Understand," and Collaborative Management" offers straightforward tasks, behaviors, and skills that can be easily mastered, making this an ideal learning tool for beginners and a valuable reference for experienced healthcare professionals.

Effectively meet a full range of communication challenges including language and cultural barriers, sexual issues, elderly patients, breaking bad news, and non-adherence.

Front cover 2
Inside front cover 3
The Medical Interview 4
Copyright page 7
Dedication 8
Contributors 9
Foreword 11
Preface 14
- What’s New? 14
- Who is the Audience? 14
- Why Use the Three Function Approach? 15
- A Note on Language 15
- References 16
Acknowledgments 17
- References 18
Table of Contents 19
Unit 1 Three Functions Of The Medical Interview 22
- 1 Learning to Interview Using the Three Function Approach: 24
  - References 27
  - Summary 27
- 2 Three Functions: 28
  - Function One: Build the Relationship 28
  - Function Two: Assess and Understand the Patient’s Problems 30
  - Function Three: Collaborate for Management 31
  - Summary 32
  - References 32
- 3 Function One: 34
  - Nonverbal Skills 35
  - Empathy 35
    - Reflection 36
    - Legitimation 38
  - Empathic Communication to Deepen Understanding (ECDU) 39
  - Personal Support 40
  - Partnership 40
  - Respect (Affirmation) 40
    - P(E)ARLS 41
  - References 41
  - Summary 41
- 4 Function Two: 43
  - Questioning Style: Open-Ended Questions and the Open-to-Closed Cone 44
  - Nonverbal Listening Behavior 44
  - RULE #2: LET THE PATIENT COMPLETE THE OPENING STATEMENT 46
  - Facilitation 46
  - Clarification and Direction 47
  - RULE #3: WHEN IN DOUBT, CHECK 48
  - Checking/Summarizing 48
  - Survey Problems: “What Else?” 49
  - Elicit the Patient’s Perspective: Ideas, Concerns, and Expectations (“ICE”) 50
    - Explore the Patient’s Ideas about the Meaning of the Illness 50
    - Elicit the Patient’s Expectations 51
    - Elicit the Patient’s Concerns about the Problems 51
  - Avoid Leading (Biased) Questions 50
  - Explore the Impact of the Illness on the Patient’s Quality of Life 51
  - Conclusion 53
  - Summary 53
  - References 53
  - Endnotes 54
- 5 Function Three: 55
  - Education About Illness: Use (e)TACCT 56
    - Using (e)TACCT: Elicit Baseline Understanding 56
    - Using (e)TACCT: Tell the Core Message 56
    - Using (e)TACCT: Ask About the Patient’s Knowledge of the Illness 57
    - Using (E)TACCT: Care About Patients’ Emotional Responses and Concerns 57
    - Using (e)TACCT: Tell-Back to Check That the Patient Understands 58
    - Using (e)TACCT: Counsel About the Details 58
  - Brief Action Planning 58
    - 1. Question One: Elicit Ideas for Change.* 59
      - “Yes” Response 59
      - “Not Sure” Response 59
      - “Not Now” Response 61
    - 2. SMART Behavioral Planning 61
    - 4. Question Two: Scale for Confidence 62
    - 5. Question Three: Arrange Accountability 62
    - 3. Elicit the Commitment Statement 62
  - Behavioral Menus and Problem Solving 63
    - 6. the Behavioral Menu 63
    - 7. Problem Solving 64
    - 8. Follow-Up 65
  - The Eight Core Skills of Brief Action Planning 66
  - Four Essential Attributes of a Brief Action Plan 66
  - Spirit of Motivational Interviewing 67
    - What About the Patient with Persistent Unhealthy Behavior Who Says “No” to Question One? 68
  - Summary 68
  - References 68
  - Conclusion 68
  - Endnotes 69
- Unit 2 Meeting the Patient 70
  - 6 Ten Common Concerns 72
    - 1. Why Should the Patient Want to Talk to or be Examined by a Student? 73
    - 2. is a Student Interview or Examination a Humiliation or Indignity for the Patient? 74
    - 4. Should I Introduce Myself as “Doctor”? if I Do, Am I Not Deceiving the Patient? 75
    - 3. How Should I Dress? Should I Wear a White Coat Even Though I Am Not a Doctor? Doesn’t This Introduce an Artificial Separation 75
    - 6. Should I Shake the Patient’s Hand? Under What Circumstances is It Acceptable to Touch the Patient? 76
    - 5. If the Patient is in Pain or Emotional Distress, Should I Continue with the Interview? 76
    - 7. If the Patient Asks Me Questions, Should I Answer Them if I Know the Answers? What Should I Do if I Do Not Know the Answers? 77
    - 8. What Do I Do if the Patient Starts Crying or if the Patient Gets Angry with Me? 78
    - 9. What Should I Do if the Patient Promises to Tell Me Some Important Secrets if I Agree to Maintain His or Her Confidence? 79
    - 10. What Should I Do if the Patient Tells Me Something His or Her Doctor Does Not Know? for Example, What if the Patient Tells 79
    - Summary 79
  - Unit 3 Structure of the Interview 80
    - 7 Opening the Interview 82
      - Establishing Goals of the Interview 82
      - Obtaining Patient Consent to Your Interview Plan 83
      - Establishing Initial Rapport 83
      - Establishing Patient Comfort 85
        
        Steps for an Effective Opening 85
      - References 85
      - Summary 85
    - 8 Chief Complaint, Problem Survey, Patient’s Perspective, and Agenda Setting 86
      - 1. Eliciting the Chief Complaint 86
        
        Responding to Emotions 87
        
        Initial Facilitation 87
        
        Checking 88
      - 2. The Problem Survey 88
        
        Probing to Completeness 90
      - 3. Elicit Patient’s Perspective: Ideas, Concerns, and Expectations (“ICE”) 90
        
        Explore Patient Ideas About the Meaning of the Illness 90
        
        Explore Patient Concerns About the Illness 91
        
        Explore Patient Expectations 91
      - Summary 92
      - References 92
      - 4. Agenda Setting 92
    - 9 History of Present Illness 93
      - Narrative Thread and Open-to-Closed Questioning 93
      - Problem Exploration: WW, QQ, AA, LC, I 95
        
        Where (Location) 95
        
        When (Timing) 96
        
        Quality 96
        
        Quantity (Severity) 97
        
        Aggravating and Alleviating Factors (Modifying Factors) 97
        
        Associated Signs and Symptoms 97
        
        Life Context 98
        
        Impact on Patient’s Quality of Life 98
      - Respond to Emotions Throughout 98
      - Summary 99
      - Complete the Narrative Thread 99
      - Complete This Process for Every Problem 99
      - References 100
      - Endnotes 100
    - 10 Past Medical History 101
      - Surgeries 102
      - Illnesses 102
      - Hospitalizations 102
      - Medications 103
      - Exposures 103
      - Allergies 103
      - Health Maintenance Practices 103
      - Injuries 103
      - Pregnancies 103
      - Summary 104
      - Reference 104
    - 11 Family History 105
      - Summary 106
      - Reference 106
    - 12 Patient Profile and Social History 107
      - Patient Profile 108
      - High-Risk Life Situations (High Stress and Low Support) 109
      - High-Risk Health Behaviors 109
      - Summary 110
      - References 110
    - 13 Review of Systems 111
      - Summary 113
      - References 113
    - 14 Mental Status 114
      - Why Every Medical Workup Should Include a Mental Status Evaluation 114
      - Brief Mental Status Examination 115
        
        1. General Appearance/Behavior 115
        
        3. Mood/Affect 116
        
        4. Thought/Perception 116
        
        2. Speech/Language 116
        
        5. Cognition/Sensorium 117
        
        6. Insight/Judgment 118
      - Summary 118
      - References 118
      - Conclusion 118
    - Unit 4 Presentation and Documentation 120
      - 15 Presentation and Documentation 122
        
        Chief Complaint 122
        
        History 123
        
        Family History 124
        
        Medications 124
        
        Past Medical History 124
        
        Examination 125
        
        Social History 125
        
        Data 125
        
        Review of Systems 125
        
        Plan 126
        
        Assessment 126
        
        Guideline for the New Patient Presentation 127
        
        Guideline for the Follow-Up Presentation 127
        
        Some Pearls for the Presentation 127
        
        Reference 128
        
        Summary and Conclusion 128
      - Unit 5 Understanding Patients' Emotional Responses to Chronic Illness 130
        
        16 Understanding Chronic Illness: 132
        
        Common Stresses of Illness 132
        
        2. Threat of Separation 133
        
        5. Threat of Loss of Body Parts 133
        
        3. Threat of Loss of Love 133
        
        6. Threat of Loss of Rationality 133
        
        1. Threat to Efficacy 133
        
        4. Threat of Loss of Body Function 133
        
        7. Threat of Pain 133
        
        Adaptive Tasks of Illness 134
        
        2. Coping with Treatment 134
        
        5. Relating to Family Members and Friends 134
        
        3. Adapting to a Variety of Health Care Providers 134
        
        1. Coping with Symptoms, Pain, and Disability 134
        
        4. Managing Emotions 134
        
        6. Preserving a Positive Self-Image 135
        
        7. Coping with the Unknown 135
        
        “Normal” Emotional Reactions to Illness and Mechanisms of Defense 135
        
        Denial, Suppression, and Repression 135
        
        Regression 135
        
        Sadness 136
        
        Anxiety 136
        
        Anger 136
        
        Summary 137
        
        References 137
        
        17 Understanding Chronic Illness: 138
        
        Persistent Anger 138
        
        Adjustment Disorder with Depressed Mood and Major Depression 139
        
        Adjustment Disorder with Anxious Mood/Anxiety Disorders 140
        
        Interviewing Strategies for Patients with Maladaptive Emotional Responses 140
        
        Persistently Angry Patients 140
        
        Patients Who Have an Adjustment Disorder with Depressed Mood or Major Depression 141
        
        Patients Who Have an Adjustment Disorder with Anxious Mood or an Anxiety Disorder 142
        
        Summary 142
        
        References 142
        
        Unnit 6 Advanced Applications 144
        
        18 Stepped-Care Advanced Skills for Action Planning 146
        
        A: Why Are Advanced Skill Necessary? 146
        
        B. Overview: The SAAP Model 148
        
        Step Three: Use Higher-Order Motivational Interviewing Skills to Meet Complex Motivational Challenges 148
        
        Step One: Respond to Distress or Discord to Meet Relational Challenges 148
        
        Step Two: Understand Benefits or Obstacles to Change to Meet Exploratory Challenges 148
        
        C. What Is Change Talk? Why Is It Important? 149
        
        D. SAAP and Change Talk: How Elicitation, Recognition, and Response to Change Talk Drive the Model 150
        
        1. Respond to Distress or Discord to Meet Relational Challenges (Advanced Application of Function One Skills) 150
        
        3. Use of Higher-Order Motivational Interviewing Skills to Meet Complex Motivational Challenges (Advanced Application of Functio 151
        
        2. Understand Benefits or Obstacles to Change to Meet Exploratory Challenges (Advanced Application of Function Two Skills) 151
        
        E. Skills and Case Study of SAAP Step One: Responding to Discord or Distress 153
        
        F. Skills and Case Studies of SAAP Step Two: Understanding Benefits or Obstacles to Change 157
        
        G. Skills and Case Study of SAAP Step Three: Using Higher-Order Motivational Interviewing Skills 161
        
        Elicit and Resolve Ambivalence 161
        
        Develop the Discrepancy 162
        
        Conclusion 164
        
        References 165
        
        Endnotes 165
        
        Summary 165
        
        19 Communicating with Patients with Chronic Illness 166
        
        Application of the Three Function Model to Chronic Illness 167
        
        Function One: Build (and Maintain) the Relationship 167
        
        Function Two: Assess and Understand the Patient 168
        
        Action Planning: 170
        
        Function Three: Collaborate for Management 170
        
        Eliciting a Goal: 170
        
        Summary 172
        
        References 172
        
        Endnotes 173
        
        20 Health Literacy and Communicating Complex Information for Decision Making 174
        
        Why Health Literacy Matters 174
        
        Health Literacy and the Three Function Model 175
        
        Function Two: Assess and Understand the Patient 175
        
        Function One: Build the Relationship 175
        
        Conveying Respect 175
        
        Function Three: Collaborate to Manage 175
        
        Communicating Complex Information for Decision Making 176
        
        Function One: Build the Relationship 176
        
        Function Two: Assess and Understand the Patient 176
        
        Elicit Expectations 176
        
        Function Three: Collaborate to Manage 177
        
        Special Considerations Using Written Materials 179
        
        References 180
        
        21 Sexual Issues in the Interview 181
        
        Why Are Sexual Issues Important? 181
        
        Function One: Build the Relationship 182
        
        Function Two: Assess and Understand the Problem 183
        
        Basic Evaluation of Risk 183
        
        Impact of Chronic Illness on Sexual Quality of Life 184
        
        Function Three: Collaborate for Management 185
        
        Managing Your Own Anxiety or Attitudinal Barriers 185
        
        Conclusion 186
        
        Managing Specific Problems 186
        
        22 Interviewing Elderly Patients 187
        
        Function One: Build the Relationship with the Elderly Patient 187
        
        Function Two: Assess and Understand the Elderly Patient 189
        
        Function Three: Collaborate for Management 189
        
        Conclusion 190
        
        Addendum 191
        
        10 Tips from the Literature for Improving Communication with Older Patients 191
        
        References 192
        
        23 Culturally Competent Medical Interviewing 193
        
        The Culture Concept 193
        
        Importance of Understanding the Patient’s Explanatory Model and Social Context 194
        
        Strategies for Eliciting Explanatory Models 195
        
        Continuum of Illness Beliefs 196
        
        Working with Interpreters in the Medical Encounter 197
        
        Enhancing the Patient-Interpreter-Physician Interaction 198
        
        Guidelines for Language Use When Working with Interpreters 199
        
        Collaborative Management and the Negotiation of Culturally Appropriate Treatment Plans 199
        
        Conclusion 201
        
        References 202
        
        24 Family Interviewing 203
        
        Situations in Which Family Members Are Often Present 203

Author's affiliation

Steven A. Cole: Professor of Psychiatry, Emeritus; Stony Broo
Julian Bird: Lately Senior Lecturer in Psychiatry; Guy's,

The Three Function Approach

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