1_Lecture 1A_Patient interview I & II

Created by Eva Choi

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What are the main purposes of the patient interview?

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The main purposes of the patient interview include:

  1. Establishing rapport with the patient.
  2. Formulating a diagnosis or hypothesis based on the information gathered.
  3. Identifying the source of symptoms or impairments, such as joint, muscle, soft tissue, or neural issues.
  4. Determining any precautions or contraindications related to irritability or pathology.
  5. Understanding the patient's goals and expectations for treatment.
  6. Conducting a baseline measurement for future comparisons.

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Purpose of the Patient Interview

What are the main purposes of the patient interview?

The main purposes of the patient interview include:

  1. Establishing rapport with the patient.
  2. Formulating a diagnosis or hypothesis based on the information gathered.
  3. Identifying the source of symptoms or impairments, such as joint, muscle, soft tissue, or neural issues.
  4. Determining any precautions or contraindications related to irritability or pathology.
  5. Understanding the patient's goals and expectations for treatment.
  6. Conducting a baseline measurement for future comparisons.
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Patient-Centred Communication

What are the key components of patient-centred communication?

  • Responsive to patient's needs & values
  • Active inclusion of the patient in decision making
  • Eliciting their understanding of the problem, concerns, expectations, and preferences
  • Should permeate the interview, physical examination, planning interventions, decisions regarding choice of interventions, and outcomes
  • Provides an opportunity to address other health problems/behaviours
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Patient-Centred Communication

What are important factors to consider in good communication during patient interviews?

Key factors include:

  • Non-verbal signals: Pay attention to body language and facial expressions.
  • Environment: Ensure a comfortable and private setting for the conversation.
  • Reliable answers: Focus on obtaining accurate and trustworthy information.
  • Question types: Use both open and closed questions to gather information effectively.
  • Techniques: Employ techniques like reflecting, summarizing, and clarifying to enhance understanding.
  • Depth of questioning: Recognize that not every question requires the same level of depth in response.
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Forms of Communication

What are the different questioning styles represented in the funnel illustration?

The funnel illustration represents the following questioning styles: OPEN, PROBE, CLOSED, and CHECK. Listening is emphasized as a crucial part of these questioning styles.

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Forms of Communication

What is the purpose of open questioning in patient interviews?

Open questioning encourages patients to express their concerns and feelings freely, allowing for a more comprehensive understanding of their issues. Examples include:

  • "What can I do for you today?"
  • "Now, is there anything else you wanted to discuss?"
  • "Are there any other areas of pain you haven't mentioned?"

This technique is particularly useful at the beginning or end of the interview.

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Forms of Communication

What is the 90-second rule in patient consultations?

The 90-second rule suggests that clinicians should allow patients to speak uninterrupted for the first 2 minutes of the consultation, using minimal encouragers. This approach helps patients feel they have adequately expressed themselves. Contrary to concerns, this method does not extend the overall length of the consultation, as most patients complete their initial history in about 90 seconds.

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Forms of Communication

What is the purpose of closed questioning in patient interviews?

Closed questioning is used to gain control of the conversation and ensure that specific questions are addressed. It typically involves questions that can be answered with a simple 'yes' or 'no'.

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Forms of Communication

What is an example of an elaborative probe in patient communication?

An example of an elaborative probe is asking, 'How does your wrist pain affect your work?' or 'Have you ever had this problem before?'

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Forms of Communication

What is the purpose of reflecting, summarizing, paraphrasing, and clarifying in communication?

These techniques help ensure understanding and validate the patient's experiences by rephrasing their statements. For example:

  • Reflecting: Acknowledges the patient's feelings or experiences.
  • Summarizing: Provides a concise overview of what has been discussed.
  • Paraphrasing: Restates the patient's words in a different way to confirm understanding.
  • Clarifying: Asks for more information to ensure accurate comprehension.
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Components of the Patient Interview

What are the key components of the patient interview?

The key components of the patient interview include:

  1. Introduction - Establishing rapport and explaining the purpose of the interview.
  2. Patient History - Gathering information about the patient's medical history, including past illnesses, surgeries, and family history.
  3. Presenting Complaint - Understanding the main reason for the patient's visit.
  4. Review of Systems - Asking about other body systems to identify any additional issues.
  5. Physical Examination - Conducting a physical assessment based on the patient's complaints.
  6. Assessment and Plan - Discussing findings and outlining the next steps in care.
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Documentation and Interpretation of Patient Interv...

How can aspects of the patient interview be documented and interpreted?

Aspects of the patient interview can be documented and interpreted through:

  1. Structured Notes - Using a standardized format to record patient information systematically.
  2. Summarization - Condensing the patient's history and findings into key points for clarity.
  3. Clinical Reasoning - Analyzing the information gathered to form a diagnosis or treatment plan.
  4. Follow-Up Questions - Documenting any additional questions that arise during the interview for further clarification.
  5. Patient Feedback - Including the patient's perspective and understanding of their condition in the documentation.
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Components of the Patient Interview

What are some strategies used in a semi-structured interview?

A range of interview strategies can be employed, including:

  1. Open-ended questions to encourage detailed responses.
  2. Probing questions to explore specific areas further.
  3. Reflective listening to confirm understanding.
  4. Clarifying questions to ensure accurate interpretation of the patient's account.
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Documentation and Interpretation of Patient Interv...

How should key information be identified during a patient interview?

Key information should be identified by marking it with an asterisk or another indicator during the interview process. This helps in highlighting important details that may require further exploration or documentation.

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Patient-Centred Communication

Why is it important to consider the value of information gathered during a patient interview?

Considering the value of information gathered is crucial to ensure that the features of the patient's account fit the clinical context. It helps in determining the relevance and potential impact of the information on diagnosis and treatment planning.

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Components of the Patient Interview

What are the key parts of a patient interview?

  1. Main problem & perceived disability
  2. Body chart – site/type of symptoms
  3. Behaviour of symptoms
  4. History (current + previous)
  5. Medical screening
  6. Social screening

The sequence of questioning may vary according to the specific problem.

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ICF Framework of Health and Disability

What are the key components of the ICF framework of health and disability?

The key components of the ICF framework include:

  1. Body Function and Structures: Refers to physiological functions of body systems and anatomical parts.
  2. Activities: Involves the execution of tasks or actions by individuals.
  3. Participation: Relates to involvement in life situations.
  4. Environmental Factors: External influences that can affect an individual's functioning.
  5. Personal Factors: Individual characteristics that can impact health and functioning.
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Components of the Patient Interview

What are the key components to assess when evaluating symptom areas in a patient?

  • Symptom areas: Identify specific locations of discomfort.
  • Symptom type: Classify symptoms as pain, numbness, etc.
  • Quality: Describe symptoms as dull, throbbing, sharp, etc.
  • Constant/intermittent: Determine if symptoms are ongoing or sporadic.
  • Depth: Assess whether the sensation is superficial or deep.
  • Radiation: Note if symptoms spread to other areas.
  • Relationship between problems: Evaluate connections between different symptoms (e.g., Pᴀ vs Pʙ).
  • Clear other areas: Ensure other potential sources of symptoms are ruled out.
  • Regional special questions: Ask about specific symptoms like pins and needles, numbness, locking, clicking, giving way, and instability.
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Behaviour of Symptoms

What are some questions to ask a patient to assess their pain?

  • How would you describe your pain?
  • What number best describes the intensity of your pain, where 0 is no pain and 10 is worst imaginable pain?
  • Is the pain deep down or is it on the surface?
  • Do you have symptoms all the time?
  • Do these symptoms occur separately?
  • Do you have any tingling, numbness or other unusual sensations?
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Behaviour of Symptoms

What are the key components to assess in the Behaviour of Symptoms (BOS)?

The key components to assess in the Behaviour of Symptoms (BOS) include:

  1. Aggravating activities - Identify activities that worsen symptoms.
  2. Easing activities - Identify activities that relieve symptoms.
  3. Severity & irritability - Evaluate how severe the symptoms are and how easily they are provoked.
  4. 24 hour pattern - Observe symptoms at different times: morning, throughout the day, and night.
  5. Daily activities - Assess how symptoms affect daily functioning.
  6. Stage of condition - Determine if the condition is improving, worsening, or stable.
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Behaviour of Symptoms

What are common aggravating factors for the temporomandibular joint during functional activities?

Common aggravating factors include yawning, chewing, and talking, which involve depression and elevation of the mandible.

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Behaviour of Symptoms

What activities are associated with aggravating factors for the shoulder?

Activities include tucking a shirt in, fastening a bra, lying on the shoulder, and reaching up, which involve joint compression and flexion.

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Behaviour of Symptoms

How does sitting affect the lumbar spine according to the common aggravating factors?

Sitting, standing, and walking are associated with flexion and extension of the lumbar spine, which can aggravate symptoms.

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Behaviour of Symptoms

What are the functional activities that aggravate the knee?

Functional activities include squatting, walking, and using stairs, which involve flexion and extension of the knee.

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Behaviour of Symptoms

What is the analysis of the activity for the hip during common aggravating factors?

Activities such as squatting, walking, side-lying with a painful hip, and using stairs involve flexion, extension, and adduction/medial rotation of the hip.

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Behaviour of Symptoms

What are the common aggravating factors for the wrist during functional activities?

Common activities include typing/writing, gripping, and turning a key, which involve sustained extension, ulnar deviation, and pronation/supination.

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Behaviour of Symptoms

What activities are associated with aggravating factors for the foot and ankle?

Walking and running are associated with dorsiflexion/plantarflexion and inversion/eversion of the foot and ankle.

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Behaviour of Symptoms

What is the impact of standing on one leg on the sacroiliac joint?

Standing on one leg, turning over in bed, and getting out of bed can cause ipsilateral upward shear and contralateral downward shear of the sacrum.

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Behaviour of Symptoms

What does the movement of pain from Pain A to Pain B suggest about the patient's condition?

The movement of pain from Pain A (located in the lower back) to Pain B (located in the legs) suggests a potential referred pain pattern, indicating that the source of the pain may originate from the lower back and affect the legs. This could imply underlying issues such as nerve involvement or musculoskeletal problems.

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Irritability Assessment

What are the three criteria used to assess irritability in patients?

  1. Activity required to initiate pain: How much activity is needed to start the pain?

  2. Severity of the pain: How severe is the pain experienced?

  3. Activity or method required to calm the pain down: What is needed to reduce the pain and how long does it take?

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Irritability Assessment

What does it indicate if symptoms take a few minutes or more to disappear?

If symptoms take a few minutes or more to disappear, it indicates that the symptoms are irritable.

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Irritability Assessment

What is the purpose of assessing irritability in a patient?

The purpose of assessing irritability is to identify patients who may not be able to tolerate a full physical examination and to determine how vigorous an examination can be performed.

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Irritability Assessment

What is the relationship between activity level and pain severity in patients with irritability?

  • Minor pain can occur with a lot of activity, which is easy to settle.
  • Severe pain can occur with a little activity, which takes a relatively long time to settle.
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Irritability Assessment

What strategies can be employed to manage symptoms during movement testing in irritable patients?

  1. Carry out movements just to (or short of) the onset of symptom provocation.
  2. Reduce the number of movements tested.
  3. Allow a pause for symptoms to settle after each movement.
  4. Avoid overpressures.
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Irritability Assessment

What is latent irritability and how does it manifest in patients?

Latent irritability refers to a condition where a movement or position induces symptoms that are delayed by several minutes. These symptoms can persist for a considerable length of time after the initial trigger.

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Irritability Assessment

What is the importance of careful management in cases of latent irritability?

Careful management is crucial in cases of latent irritability to avoid unnecessary exacerbation of symptoms, which can lead to prolonged discomfort and complications for the patient.

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Behaviour of Symptoms

What questions can be asked to assess pain behavior throughout the day?

  • How is your pain first thing in the morning?
  • What are your symptoms like throughout the day/by the end of the day?
  • Do you have difficulty getting to sleep because of your pain?
  • Which positions are most comfortable or uncomfortable?
  • Are you woken by symptoms, and if so how many times?
  • Can you get back to sleep?
  • How long does it take to get back to sleep?
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Components of the Patient Interview

What questions should be asked to understand the onset of symptoms during a patient interview?

  • When did you first notice the symptoms?
  • What symptoms did you notice first?
  • Was there a sudden or slow onset?
  • Was there a known or unknown cause that provoked the onset of symptoms, such as trauma or change in lifestyle?
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Components of the Patient Interview

Why is it important to ask about the progression of symptoms in a patient interview?

Asking about the progression of symptoms helps to determine whether the condition has remained the same, improved, or worsened, which is crucial for assessing the patient's health status and guiding treatment decisions.

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Components of the Patient Interview

How can questioning each symptom help in a patient interview?

Questioning each symptom helps to confirm the relationship between symptoms, providing a clearer understanding of the patient's condition and aiding in accurate diagnosis and treatment planning.

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Components of the Patient Interview

What questions should be asked to understand a patient's history of episodes?

  1. Have you had any previous experiences like this?

  2. Can you describe the first episode in detail?

  3. What do you think caused or contributed to it?

  4. How many episodes have you experienced?

  5. Is it the same each time?

  6. Are you 100% between episodes?

  7. Have you had any previous treatment and what were the effects?

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Components of the Patient Interview

What social factors should be considered during patient screening?

Key social factors include:

  1. Age
  2. Occupation
  3. Family responsibilities
  4. Leisure and physical activities
  5. Perspectives, experiences, and expectations
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Patient-Centred Communication

What questions can be asked to understand a patient's coping mechanisms and expectations regarding their problem?

Questions to ask include:

  1. "Have you had time off work because of your problem?"
  2. "What are you doing to cope with your pain? What do you understand to be the cause of your problem?"
  3. "What are you expecting will help you?"
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Components of the Patient Interview

What does the acronym THREADS stand for in a systems review during a medical screening?

THREADS stands for:

  • Thyroid
  • Heart
  • Rheumatoid Arthritis
  • Epilepsy
  • Asthma
  • Diabetes
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Red Flags in Patient Assessment

What are some red flags that may indicate the presence of serious conditions requiring urgent evaluation?

  • Constant progressive, non-mechanical pain (no relief with bed rest)
  • Thoracic pain
  • History of malignant tumor
  • Age of onset <20 or >55 years
  • Violent trauma
  • Prolonged use of corticosteroids
  • Drug abuse or immunosuppression
  • Fever
  • Systemically unwell
  • Unexplained weight loss
  • Widespread neurology
  • Structural deformity
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Yellow Flags in Patient Assessment

What are some yellow flags that may affect a patient's perception of pain?

  • A belief that pain is harmful
  • Fear avoidance behavior
  • Low mood and social withdrawal
  • Expectation that passive treatment rather than active participation will help
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Components of the Patient Interview

What should be done to reconfirm the patient's main complaint at the end of the interview?

Reconfirm briefly with the patient your understanding of their main complaint.

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Components of the Patient Interview

What opportunity should be offered to the patient at the end of the interview?

Offer the opportunity to add anything they feel is important.

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Components of the Patient Interview

What key information should be highlighted for further examination or treatment?

Highlight (asterisk) key information for further examination, treatment, or reassessment.

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Components of the Patient Interview

How can you identify if information is missing at the end of the patient interview?

Identify if information is missing by reviewing the details discussed during the interview.

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Components of the Patient Interview

What should be assessed regarding the features of the patient's condition at the end of the interview?

Assess if the features fit the patient's main complaint and overall presentation.

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Components of the Patient Interview

What are the components of the patient interview?

The components of the patient interview typically include:

  1. Introduction - Establishing rapport and explaining the purpose of the interview.
  2. Patient History - Gathering information about the patient's medical history, including past illnesses, surgeries, and family history.
  3. Presenting Complaint - Understanding the main reason for the patient's visit.
  4. Review of Systems - A systematic approach to inquire about different body systems to identify any additional issues.
  5. Physical Examination - Conducting a physical assessment based on the information gathered.
  6. Assessment and Plan - Discussing findings and creating a plan for treatment or further investigation.
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Documentation and Interpretation of Patient Interv...

How can aspects of the patient interview be documented and interpreted?

Aspects of the patient interview can be documented and interpreted through the following steps:

  1. Accurate Note-Taking - Record key points during the interview, including patient responses and observations.

  2. Organized Structure - Use a structured format (e.g., SOAP notes) to categorize information:

    • Subjective: Patient's reported symptoms and feelings.
    • Objective: Observations and findings from the physical examination.
    • Assessment: Clinician's interpretation of the information.
    • Plan: Proposed next steps for treatment or further evaluation.
  3. Reflective Interpretation - Analyze the information to identify patterns, potential diagnoses, and treatment options.

  4. Follow-Up - Document any follow-up actions or referrals based on the interview findings.

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