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The Einstein Geriatrics Fellowship Core Curriculum
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The Einstein Geriatrics Fellowship Core Curriculum
•A 20 part lecture series designed for first
year geriatrics fellows
•Covers the ACGME content areas for
fellowship training
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Communication and Interviewing Skills with the Geriatric Patient
Debra Greenberg, PhD
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Objectives
• To review goals in interviewing older persons and their caregivers
• To review interviewing skills that will facilitate interactions with an older adult
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Introductions
• How do you introduce self?
• How do you address the older adult?
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Conditions for the Geriatric Interview
• Privacy
• Environment of the room
• Ability to see and hear provider
• Compensation for patients’ disabilities
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Modification for the Hearing Impaired Person
• Use slow, clear speech • Allow adequate time for the patient to
respond• Assure adequate lighting to allow for
simultaneous lip reading• Maintain visual contact "face-to-face" to
allow for lip reading• High-pitched voices should be deepened
Most hearing loss is high frequency
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Modifications in Interviewing With an Interpreter
• Interpreter vs. Translator
• Interpreter should be non- family members whenever possible
• The patient's permission should be obtained prior to using a family member/friend as a translator
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Modification in Interviewing People with Dementia
• Families and significant others should be interviewed separately whenever possible
• When possible older person’s permission should be obtained prior to separate interviews
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Geriatric Social History
• Is there social support?
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Geriatric Social History
• Personal History
• Place of origin
• Level of education
• Marital status and history
• Children/grandchildren and their health
• Religious background
• Habits: Alcohol, Cigarettes, Exercise
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Geriatric Social HistoryInformal Support
• Who do they live with? • Contact with family and friends
Type/frequency of interaction -who visits?• Activities/hobbies - where do they go?• Significant losses: function abilities,
lifestyle, significant others • Plans for the future
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Geriatric Social HistoryFormal Support
• Current Financial Status
• Insurance
• Formal Supports – eg. home care agency
• Involved Agencies
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“The 3Ps”
• Presenting issue
• Precipitating issue
• Perpetuating issue
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Determine the Purpose of theContact
• Presenting Issue
• Why is the person here? What do they want?
Routine health care
New problem/new provider
• A problem for the patient/ caregiver
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Purpose of theContact
Precipitating Issues
• What is their previous experience with health care? With other MD’s?
• How have they negotiated the health care system in the past?
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Purpose of theContact
• Perpetuating issues
• What makes health practices and attitudes hard to change?
• What do we want?
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Style of Inquiry
• Repeat or rephrase
• Observe themes
Shifts in topics, evasiveness
• Follow-up on inconsistencies
• Tolerate silence
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Style of inquiry
• Questions
Open ended – “Who do you live with?”
Multiple choices - “ Which of these do you want to focus on today?”
Closed ended – “How many drinks do you have a day?”
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Style of Inquiry
• Listening
• Observing - hidden or unspoken clues
• Interrupting
• Using silence
• Double tasking, documenting while talking or listening ?
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Challenges
• Conflict
• Losing one’s temper
• Dual interview
• Door knob problems
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What do our Patients Want?
• To establish and maintain relationships with medical staff
• To maintain a sense of control over their bodies and lives
• To involve important people in their lives in their health care or to defer to others or to maintain privacy and independence from others
• To have their needs and fears heard• To have information about their health including
prognosis, as requested
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Is there a Joint Treatment Plan?
Resources and Limitations in Planning • Impact of past or present roles, education,
employment, and values, health care beliefs• Relationships and current support systems• Reaction coping style• Resources financial, insurance, short and
long term plans
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Reflection and Review of the Interview
• Form an impression from verbal and non-verbal clues of patient’s health care goals
• Were the patient’s needs understood?• Were you understood?• Was the reason for the visit completed? • Left open? Further negotiation needed
with the patient?
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What is a good patient interaction?
• Balance the need for a good quality of care and a good quality of life
• Determine patient preference, diagnosis and treatment options
• Engage in joint treatment plan• Accomplish with empathy for the
challenges of aging and our common humanity