Interviewing and the Health History

Interviewing and the Health HistorybyArif Yahya

THE FORMAT OF THE COMPREHENSIVE HEALTH HISTORYIdentifying DataSource and Reliability of History (smbr & hal yg dpt dprcya )Chief Complaint (kluhan utama)History of Present Illness (yg drskn skrg)Medications, Allergies, Tobacco, Alcohol and Drugs Past History (Childhood IllnessAdult Illness: Medical, Surgical, Ob/Gyn, Psychiatric, Health MaintenanceFamily HistoryPersonal and Social HistoryReview of Systems

Getting Ready: The Approach to the InterviewTaking Time for Self-ReflectionSelf-reflection is a continual part of professional development in clinical work. It brings a deepening personal awareness to our work with patients and is one of the most rewarding aspects of providing patient care.Getting Ready: The Approach to the InterviewReviewing the ChartBefore seeing the patient, review his or her medical record, or chart. The purpose of reviewing the chart is partly to gather information and partly to develop ideas about what to explore with the patient. Look closely at the identifying data (age, gender, address, health insurance), the problem list, the medication list, and other details, such as the documentation of allergies.

Getting Ready: The Approach to the InterviewSetting Goals for the InterviewBefore you begin talking with a patient, it is important to clarify your goals for the interview. As a student, your goal may be to obtain a complete health history so that you can submit a write up to your teacher.Getting Ready: The Approach to the InterviewReviewing Clinician Behavior and AppearanceJust as you observe the patient throughout the interview, the patient will be watching you. Consciously or not, you send messages through both your words and your behavior. Be sensitive to those messages and manage them as well as you can.Getting Ready: The Approach to the InterviewImproving the EnvironmentTry to make the setting as private and comfortable as possible. Although you may have to talk with the patientunder difficult circumstances, such as a two-bed room or the corridor of a busy emergency department, a proper environment improves communication.Getting Ready: The Approach to the InterviewTaking NotesAs a novice you will need to write down much of what you learn during the interview. Even though experienced clinicians seem to remember a great deal of the interview without taking notes, no one can rememberall the details of a comprehensive history.Learning About the Patient:The Process of InterviewingTHE SEQUENCE OF THE INTERVIEW (urtn intrview)Greeting the patient and establishing rapportInviting the patients storyEstablishing the agenda for the interviewExpanding and clarifying the patients story; generating and testing diagnostic (see below)HypothesesCreating a shared understanding of the problem (see below)Negotiating a plan (includes further evaluation, treatment, and patient education)Planning for follow-up and closing the interview.Expanding and Clarifying the Health History (the Patients Perspective)THE SEVEN ATTRIBUTES OF A SYMPTOM1. Location. Where is it? Does it radiate?2. Quality. What is it like?3. Quantity or severity. How bad is it? (For pain, ask for a rating on a scale of 1-10.)4. Timing. When did (does) it start? How long did (does) it last? How often did (does) it come?5. Setting in which it occurs. Include environmental factors, personal activities, emotional reactions, or other circumstances that may have contributed to the illness.6. Remitting or exacerbating factors. Does anything make it better orworse?7. Associated manifestations. Have you noticed anything else that accompanies it?Creating a shared understanding of the problemEXPLORING THE PATIENTS PERSPECTIVEThe patients thoughts about the nature and the cause of the problemThe patients feelings, especially fears, about the problemThe patients expectations of the clinician and health careThe effect of the problem on the patients lifePrior personal or family experiences that are similarTherapeutic responses the patient has already triedFacilitating the Patients Story:The Techniques of Skilled InterviewingTHE TECHNIQUES OF SKILLED INTERVIEWING Active listening Adaptive questioning (See below) Nonverbal communication Facilitation Echoing Empathic responses Validation Reassurance Summarization Highlighting transitionsFacilitating the Patients Story:The Techniques of Skilled InterviewingADAPTIVE QUESTIONING:OPTIONS FOR CLARIFYING THE PATIENTS STORY Directed questioningfrom general to specific Questioning to elicit a graded response Asking a series of questions, one at a time Offering multiple choices for answers Clarifying what the patient meansAdapting Interviewing Techniquesto Specific SituationsThe Silent PatientThe Talkative PatientThe Anxious PatientThe Crying PatientThe Confusing PatientThe Angry or Disruptive PatientThe Patient With a Language BarrierThe Patient With Reading ProblemsThe Patient With Impaired HearingThe Patient With Impaired VisionThe Patient With Limited IntelligenceThe Poor HistorianThe Patient With Personal ProblemsSpecial Aspects of InterviewingCultural CompetenceThe Alcohol and Drug HistoryThe Sexual HistoryDomestic and Physical ViolenceThe Mental Health HistoryDeath and the Dying PatientSexuality in the ClinicianPatient RelationshipEthical ConsiderationsTHE TAVISTOCK PRINCIPLESRights: People have a right to health and health care.Balance: Care of individual patients is central, but the health of populations is alsoour concern.Comprehensiveness: In addition to treating illness, we have an obligation toease suffering, minimize disability, prevent disease, and promote health.Cooperation: Health care succeeds only if we cooperate with those we serve,each other, and those in other sectors.Improvement: Improving health care is a serious and continuing responsibility.Safety: Do no harm.Openness: Being open, honest, and trustworthy is vital in health care.Interviewing Patients of Different AgesTalking With ChildrenEstablishing Rapport (Working With FamiliesMULTIPLE AGENDASTHE FAMILY AS A RESOURCEHIDDEN AGENDASTalking With AdolescentsTalking With Aging Patients

Talking With Aging Patients

ACTIVITIES OF DAILY LIVING (ADLs)

Physical ADLs Instrumental ADLsBathing Using the telephoneDressing ShoppingToileting Preparing foodTransfers HousekeepingContinence LaundryFeeding TransportationManaging moneyTaking medicine