Save
A
d
v
a
n
c
e
H
e
al
t
h
A
s
s
e
s
s
m
e
,n
t
Terms in this set (215)
Introduction Good Morning
How would you like to be addressed
Most patient based on studies like to shake
hands with their primary care doctor
What bring you into the clinic today
Tell me more about (open ended question)
Let the patient Patient Diagnose Follow the patients leads
her/himself
Use Continuers
example:' "I see.", "Tell me more.
", "Go on"."
Ask Directly
-Ask the patient directly what they think they
have.
Getting all the facts-Dos Ask specific close ended questions:
- "Does the pain radiate?"
-"Have you tried (medications, exercise,
ANYTHING) to alleviate the pain?"
Go back to open-ended questions:
- Physician: "Do you have other symptoms
when the pain comes?"
- Patient: "No"
- Physician: "Specifically, do you feel
nauseous?"
- "Have you had fever?"
,Getting all the Facts-Dont's -Don't inquire into more than 2 symptoms with
1 question
-Don't bias the answer, "You don't have fever,
do you?" vs. "Have you had fever?"
A patient comes in with the "Tell me more about your stomach pain."
complaint, "My stomach hurts."
Which of the following is the best
next thing to ask or say to the
patient to obtain an accurate and
efficient history?
Which of the following Introduce yourself positively and confidently.
recommendations is the most
appropriate when starting to take
a new patient's history?
In a survey of internal medicine HISTORY
faculty and residents, what aspect
of a patient-doctor interaction did
most believe was of greatest
importance in making an accurate
diagnosis?
A 16-year-old girl complains of a "Are you sexually active?"
thick yellow malodorous vaginal
discharge over the past 2 weeks.
It is accompanied by itching and
burning on urination. Which of the
following questions is most
appropriate in obtaining an
accurate and efficient history?
A newly single 36-year-old woman "Tell me more about that feeling."
presents to your office for
evaluation. After you introduce
yourself and ask what brings her
to your clinic today, she responds
"I feel a lot more tired than usual."
What is the next best response?
, What are the different types of Identifying patient demographics like name,
Histories? date of birth, address, age
Presenting Complaint: "What brought you in
today"
History of presenting complaint
Past psychiatric history
Social and developmental history
Past Medical and Surgical History
Medications/Allergies
Family History
Taking the History -Make sure the patients comfortable during the
interview process-provide a relaxed,
supportive environment with no interruptions.
Be attentive, caring and concerned.
-The patient needs to feel safe and have trust
and confidence in the doctor.
=The therapeutic alliance is critical to gather
information and complete a mental status
exam
A
d
v
a
n
c
e
H
e
al
t
h
A
s
s
e
s
s
m
e
,n
t
Terms in this set (215)
Introduction Good Morning
How would you like to be addressed
Most patient based on studies like to shake
hands with their primary care doctor
What bring you into the clinic today
Tell me more about (open ended question)
Let the patient Patient Diagnose Follow the patients leads
her/himself
Use Continuers
example:' "I see.", "Tell me more.
", "Go on"."
Ask Directly
-Ask the patient directly what they think they
have.
Getting all the facts-Dos Ask specific close ended questions:
- "Does the pain radiate?"
-"Have you tried (medications, exercise,
ANYTHING) to alleviate the pain?"
Go back to open-ended questions:
- Physician: "Do you have other symptoms
when the pain comes?"
- Patient: "No"
- Physician: "Specifically, do you feel
nauseous?"
- "Have you had fever?"
,Getting all the Facts-Dont's -Don't inquire into more than 2 symptoms with
1 question
-Don't bias the answer, "You don't have fever,
do you?" vs. "Have you had fever?"
A patient comes in with the "Tell me more about your stomach pain."
complaint, "My stomach hurts."
Which of the following is the best
next thing to ask or say to the
patient to obtain an accurate and
efficient history?
Which of the following Introduce yourself positively and confidently.
recommendations is the most
appropriate when starting to take
a new patient's history?
In a survey of internal medicine HISTORY
faculty and residents, what aspect
of a patient-doctor interaction did
most believe was of greatest
importance in making an accurate
diagnosis?
A 16-year-old girl complains of a "Are you sexually active?"
thick yellow malodorous vaginal
discharge over the past 2 weeks.
It is accompanied by itching and
burning on urination. Which of the
following questions is most
appropriate in obtaining an
accurate and efficient history?
A newly single 36-year-old woman "Tell me more about that feeling."
presents to your office for
evaluation. After you introduce
yourself and ask what brings her
to your clinic today, she responds
"I feel a lot more tired than usual."
What is the next best response?
, What are the different types of Identifying patient demographics like name,
Histories? date of birth, address, age
Presenting Complaint: "What brought you in
today"
History of presenting complaint
Past psychiatric history
Social and developmental history
Past Medical and Surgical History
Medications/Allergies
Family History
Taking the History -Make sure the patients comfortable during the
interview process-provide a relaxed,
supportive environment with no interruptions.
Be attentive, caring and concerned.
-The patient needs to feel safe and have trust
and confidence in the doctor.
=The therapeutic alliance is critical to gather
information and complete a mental status
exam
