Advanced Health Assessment & Differential
Diagnosis Module 1 exam
Building a History -"Building" a history rather than "taking" one because you
and your patient are involved in a joint effort
-Context of that relationship in emotional, physical, and
ethical terms
-Verbal and nonverbal behavior that you may adapt to your
individual comfort and style
-Approaches to structure of a history with adaptations
suggested for age, gender, and disability
,Developing a Relationship with the Patient -The first meeting with the patient sets the tone for a
successful partnership
-You will be open, flexible, and eager to deal with
questions and explanations
-You will explain the boundaries of your practice and the
degree of your availability in any situation
-Trust evolves from honest and
candor Primary Objectives:
-To discover the details about a patient's concern
-To explore expectations for the encounter
-To display genuine interest, curiosity, and partnership
-To prevent misinterpretations and misperceptions, you
must make every effort to sense the world of the
patient as that patient sees it
Patient-Centered Care Defined by the Institute of Medicine as:
-Respecting and responding to patients wants, needs and
preferences, so that they can make choices in their care that
best fit their individual circumstances
Your own beliefs, attitudes, and values cannot be discarded,
but you do have to discipline them
Effective Communication Establishing a positive patient relationship depends
on communication built on:
-Courtesy
-Comfort
-Connection
-Confirmation
-Confidentiality
Enhancing Patient Responses Open-ended question
-Allows patient discretion about the extent of an answer
Direct question
-Seeks specific information
Leading question
-May limit the information provided to what the patient
thinks you want to know
If the patient does not understand what you are asking,
remember to:
Play audio for this term
-Facilitate: Encourage your patient to say more
-Reflect: Repeat what you have heard
-Clarify: Ask "what do you mean?"
-Empathize: Show understanding and acceptance
-Confront: Address disturbing patient behavior
-Interpret: Repeat what you have heard to confirm the
patient's meaning
,Potenital Barriers to Communication -Curiosity about you
-Anxiety
-Silence
-Depression
-Crying
-Physical intimacy
-Emotional intimacy
-Seduction
-Anger
-Avoidance
-Financial considerations
The History Taking the history usually begins your relationship
with the patient
The Patient History -Identify those matters the patient defines as problems
-Establish a sense of the patient's reliability
-Consider the potential for intentional or unintentional
suppression or underreporting of information
-Remain in a constant state of subject evaluation of the
patient's words and behaviors
-Adapt to the modifications that age pregnancy, and
physical and emotional disabilities mandate
Setting for the Interview -Comfort for all involved
-Removal of physical barriers
-Good lighting
-Privacy
-Relative quiet
-Unobtrusive access to clock
Structure of the History -The identifiers: name date, time, age, gender,
race, occupation, and referral source
-Chief concern
-History of present illness (HPI)
-Past medical history (PMH)
-Family History (FH)
-Personal and social history (SH)
-Review of systems (ROS)
, Building the History -Introduce yourself
-Address patient properly
-Be courteous
-Make eye contact
-Do not overtire the patient
-Do not be judgmental
-Be flexible
-Avoid medical jargon
-Take notes sparingly
-Avoid leading questions
-Start with general concerns, then move to specific
descriptions
-Clarify responses with where, when, what, how, and why
questions
-Verify and summarize what you have heard
Approaches to Sensitive Issues -Ensure privacy
-Be direct and firm
-Do not apologize for broaching the issue
-Do not preach
-Use language that is understandable
-Do not push too hard
Sensitive Issues -Alcohol and drug use
-Intimate partner violence
-Spirituality
-Sexuality
CAGE questionnaire The CAGE questionnaire was developed in 1984 by Dr.
John Ewing, and it includes four interview question
designed to help diagnose alcoholism.
C - Cutting down
A - Annoyance by criticism
G - Guilty feeling
E - Eye openers
Probing questions may be asked as follow-up questions to
the CAGE questionnaire
TACE Questionnaire T - How many drinks does it TAKE to make you feel high?
A - Have people ANNOYED you by criticizing your
drinking? C - Have you felt you ought to CUT down on
your drinking?
E - Have you ever had an EYE-OPENER drink first thing
in the morning to steady your nerve or get rid of a
hangover?
Diagnosis Module 1 exam
Building a History -"Building" a history rather than "taking" one because you
and your patient are involved in a joint effort
-Context of that relationship in emotional, physical, and
ethical terms
-Verbal and nonverbal behavior that you may adapt to your
individual comfort and style
-Approaches to structure of a history with adaptations
suggested for age, gender, and disability
,Developing a Relationship with the Patient -The first meeting with the patient sets the tone for a
successful partnership
-You will be open, flexible, and eager to deal with
questions and explanations
-You will explain the boundaries of your practice and the
degree of your availability in any situation
-Trust evolves from honest and
candor Primary Objectives:
-To discover the details about a patient's concern
-To explore expectations for the encounter
-To display genuine interest, curiosity, and partnership
-To prevent misinterpretations and misperceptions, you
must make every effort to sense the world of the
patient as that patient sees it
Patient-Centered Care Defined by the Institute of Medicine as:
-Respecting and responding to patients wants, needs and
preferences, so that they can make choices in their care that
best fit their individual circumstances
Your own beliefs, attitudes, and values cannot be discarded,
but you do have to discipline them
Effective Communication Establishing a positive patient relationship depends
on communication built on:
-Courtesy
-Comfort
-Connection
-Confirmation
-Confidentiality
Enhancing Patient Responses Open-ended question
-Allows patient discretion about the extent of an answer
Direct question
-Seeks specific information
Leading question
-May limit the information provided to what the patient
thinks you want to know
If the patient does not understand what you are asking,
remember to:
Play audio for this term
-Facilitate: Encourage your patient to say more
-Reflect: Repeat what you have heard
-Clarify: Ask "what do you mean?"
-Empathize: Show understanding and acceptance
-Confront: Address disturbing patient behavior
-Interpret: Repeat what you have heard to confirm the
patient's meaning
,Potenital Barriers to Communication -Curiosity about you
-Anxiety
-Silence
-Depression
-Crying
-Physical intimacy
-Emotional intimacy
-Seduction
-Anger
-Avoidance
-Financial considerations
The History Taking the history usually begins your relationship
with the patient
The Patient History -Identify those matters the patient defines as problems
-Establish a sense of the patient's reliability
-Consider the potential for intentional or unintentional
suppression or underreporting of information
-Remain in a constant state of subject evaluation of the
patient's words and behaviors
-Adapt to the modifications that age pregnancy, and
physical and emotional disabilities mandate
Setting for the Interview -Comfort for all involved
-Removal of physical barriers
-Good lighting
-Privacy
-Relative quiet
-Unobtrusive access to clock
Structure of the History -The identifiers: name date, time, age, gender,
race, occupation, and referral source
-Chief concern
-History of present illness (HPI)
-Past medical history (PMH)
-Family History (FH)
-Personal and social history (SH)
-Review of systems (ROS)
, Building the History -Introduce yourself
-Address patient properly
-Be courteous
-Make eye contact
-Do not overtire the patient
-Do not be judgmental
-Be flexible
-Avoid medical jargon
-Take notes sparingly
-Avoid leading questions
-Start with general concerns, then move to specific
descriptions
-Clarify responses with where, when, what, how, and why
questions
-Verify and summarize what you have heard
Approaches to Sensitive Issues -Ensure privacy
-Be direct and firm
-Do not apologize for broaching the issue
-Do not preach
-Use language that is understandable
-Do not push too hard
Sensitive Issues -Alcohol and drug use
-Intimate partner violence
-Spirituality
-Sexuality
CAGE questionnaire The CAGE questionnaire was developed in 1984 by Dr.
John Ewing, and it includes four interview question
designed to help diagnose alcoholism.
C - Cutting down
A - Annoyance by criticism
G - Guilty feeling
E - Eye openers
Probing questions may be asked as follow-up questions to
the CAGE questionnaire
TACE Questionnaire T - How many drinks does it TAKE to make you feel high?
A - Have people ANNOYED you by criticizing your
drinking? C - Have you felt you ought to CUT down on
your drinking?
E - Have you ever had an EYE-OPENER drink first thing
in the morning to steady your nerve or get rid of a
hangover?
