Chapter 1 (Approach to the Clinical Encounter)
Sequence of the Clinical Encounter page.4
1. Initiating the encounter
Setting the stage/preparation
Greet the patient and establish an initial rapport
2. Gather information
Initial information gathering
Exploring patients' perspectives of illness
Exploring biomedical perspectives of disease, including relevant
background and context
3. Performing physical examination
4. Explaining and planning
Provide the correct amounts and types of information
Negotiate a plan of action
Shared decision making
5. Closing the encounter
Exploring the patient’s perspective page.14 Box 1-8 (F-I-F-
E)
The patient's Feelings, including fears or concerns about the problem
The patient's Ideas about the nature and cause of the problem
The effect of the problem on the patient's life and Function
The patient's Expectations of the disease, of the clinician, or of health care,
often based on prior personal or family experiences
Shared decision-making page.16
Shared decision making has been called the pinnacle of patient-centered
care. experts recommend a three-step approach:
1. Introducing choices and describing options using patient decision
support tools when available
, 2. Exploring patient preferences and moving to a decision
3. Checking that the patient is ready to make a decision and offering
more time if needed.
Social determinants of health page.18 Box 1-11
Economic stability (employment, food insecurity, housing instability,
poverty)
Education (early childhood education and development, enrollment in
higher education, high school graduation, language and literacy)
Social and community context (civic participation, discrimination,
incarceration, social cohesion)
Health and health care (access to healthcare, access to primary care,
health literacy)
Neighborhood and built environment (access to food that supports
healthy eating, patterns, crime and violence, environmental conditions,
quality of housing)
Cultural humility page.21 Box 1-13
3 dimensions of cultural humility
1. Self-awareness. learn about your own biases; we all have them
2. Respectful communication. Work to eliminate assumptions about
what is normal. Learn directly from your patients; they are experts on
their culture and illness.
3. Collaborative partnerships. Build your patient relationships on
respect and mutually acceptable plans.
Core values of medical ethics page.25
Non-maleficence (first, do no harm). Directive that healthcare
professionals should avoid causing harm to patients and minimize the
negative effects of treatment.
Beneficence. A dictum that clinicians are to act for the patient's good by
preventing or treating disease
Respect for autonomy. Commitment to accept the choices patients with
decisional capacity make without undergoing treatments, including to reject
treatment.
, Decisional capacity. Ability to make autonomous choices that clinicians
should respect
Confidentiality. Duty to prevent the disclosure of patient’s personal
information to parties who are not authorized to learn that information
Informed consent. The principle that clinicians must elicit patients'
voluntary informed authorization to test or treat them for illness or injury
because patients cannot consent to treatment without knowing what they
are being treated for, this principle also encompasses the responsibility to
inform patients of diagnosis, prognosis, and treatment alternatives.
Truth-telling. The clinician should disclose information beyond that
required by informed consent that may be relevant to patients(IG the
number of similar procedures that the physician has performed)
Justice. Value that all patients with similar medical needs should receive
similar medical treatment and should be treated fairly by clinicians.
Chapter 2 (Interviewing, Communication, and Interpersonal Skills)
Skilled interviewing techniques page.44 Box 2-1
Active or attentive listening, guided questioning, empathic
responses, summarization, transitions, partnering, validation,
empowering the patient, reassurance, appropriate verbal
communication, appropriate nonverbal communication.
Working with a medical interpreter page.54
Interprofessional communication page.59 Box 2-10 Table 2-2
S- Situation (I am… I am calling because… I have a patient who is…).
B- background (the patient was admitted on…. Because of….)
A- assessment (I think this patient is likely having a….)
R- recommendation (let us transfer… let us monitor and then….)
Challenging patient situations and behaviors page.60
Silent, talkative, with confusing narrative, with altered state or cognition,
with emotional liability, angry or aggressive, flirtatious, discriminatory, with
hearing loss, with low or impaired vision, with limited intelligence,
burdened by personal problems, non adherent, with low literacy, with low
Sequence of the Clinical Encounter page.4
1. Initiating the encounter
Setting the stage/preparation
Greet the patient and establish an initial rapport
2. Gather information
Initial information gathering
Exploring patients' perspectives of illness
Exploring biomedical perspectives of disease, including relevant
background and context
3. Performing physical examination
4. Explaining and planning
Provide the correct amounts and types of information
Negotiate a plan of action
Shared decision making
5. Closing the encounter
Exploring the patient’s perspective page.14 Box 1-8 (F-I-F-
E)
The patient's Feelings, including fears or concerns about the problem
The patient's Ideas about the nature and cause of the problem
The effect of the problem on the patient's life and Function
The patient's Expectations of the disease, of the clinician, or of health care,
often based on prior personal or family experiences
Shared decision-making page.16
Shared decision making has been called the pinnacle of patient-centered
care. experts recommend a three-step approach:
1. Introducing choices and describing options using patient decision
support tools when available
, 2. Exploring patient preferences and moving to a decision
3. Checking that the patient is ready to make a decision and offering
more time if needed.
Social determinants of health page.18 Box 1-11
Economic stability (employment, food insecurity, housing instability,
poverty)
Education (early childhood education and development, enrollment in
higher education, high school graduation, language and literacy)
Social and community context (civic participation, discrimination,
incarceration, social cohesion)
Health and health care (access to healthcare, access to primary care,
health literacy)
Neighborhood and built environment (access to food that supports
healthy eating, patterns, crime and violence, environmental conditions,
quality of housing)
Cultural humility page.21 Box 1-13
3 dimensions of cultural humility
1. Self-awareness. learn about your own biases; we all have them
2. Respectful communication. Work to eliminate assumptions about
what is normal. Learn directly from your patients; they are experts on
their culture and illness.
3. Collaborative partnerships. Build your patient relationships on
respect and mutually acceptable plans.
Core values of medical ethics page.25
Non-maleficence (first, do no harm). Directive that healthcare
professionals should avoid causing harm to patients and minimize the
negative effects of treatment.
Beneficence. A dictum that clinicians are to act for the patient's good by
preventing or treating disease
Respect for autonomy. Commitment to accept the choices patients with
decisional capacity make without undergoing treatments, including to reject
treatment.
, Decisional capacity. Ability to make autonomous choices that clinicians
should respect
Confidentiality. Duty to prevent the disclosure of patient’s personal
information to parties who are not authorized to learn that information
Informed consent. The principle that clinicians must elicit patients'
voluntary informed authorization to test or treat them for illness or injury
because patients cannot consent to treatment without knowing what they
are being treated for, this principle also encompasses the responsibility to
inform patients of diagnosis, prognosis, and treatment alternatives.
Truth-telling. The clinician should disclose information beyond that
required by informed consent that may be relevant to patients(IG the
number of similar procedures that the physician has performed)
Justice. Value that all patients with similar medical needs should receive
similar medical treatment and should be treated fairly by clinicians.
Chapter 2 (Interviewing, Communication, and Interpersonal Skills)
Skilled interviewing techniques page.44 Box 2-1
Active or attentive listening, guided questioning, empathic
responses, summarization, transitions, partnering, validation,
empowering the patient, reassurance, appropriate verbal
communication, appropriate nonverbal communication.
Working with a medical interpreter page.54
Interprofessional communication page.59 Box 2-10 Table 2-2
S- Situation (I am… I am calling because… I have a patient who is…).
B- background (the patient was admitted on…. Because of….)
A- assessment (I think this patient is likely having a….)
R- recommendation (let us transfer… let us monitor and then….)
Challenging patient situations and behaviors page.60
Silent, talkative, with confusing narrative, with altered state or cognition,
with emotional liability, angry or aggressive, flirtatious, discriminatory, with
hearing loss, with low or impaired vision, with limited intelligence,
burdened by personal problems, non adherent, with low literacy, with low
