HIS 230 - Patient Histories and Diagnostic Counseling

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  • 1. PATIENT/CLIENT HISTORIES & DIAGNOSTIIC COUNSELING Patient/Client History Proper documentation of a patient/client history may be as important as the audiometric examination itself.
  • 2. PATIENT/CLIENT HISTORIES & DIAGNOSTIIC COUNSELING Patient/Client History  Any case history form must provide space for a statement of the perceived problem— including why professional services are being sought.  It is helpful to know the patient/client’s own attitude about the appointment.
  • 3. PATIENT/CLIENT HISTORIES & DIAGNOSTIIC COUNSELING Patient/Client History Knowing the reason for the patient/client visit can provide powerful insights before the rest of the history has been completed or the first test has been administered.
  • 4. PATIENT/CLIENT HISTORIES & DIAGNOSTIIC COUNSELING Patient/Client History Information to be collected should include:  Family history of ear disease  Family history of hearing impairment  History of noise exposure  History of head or ear trauma  Past related ear surgery, childhood illness/disease  Reports of vertigo and/or tinnitus  History of hearing instrument use
  • 5. DIAGNOSTIIC COUNSELING
  • 6. PATIENT/CLIENT HISTORIES & DIAGNOSTIIC COUNSELING Patient/Client History  Carefully reviewing the completed Patient History Form with the patient/client is important.  They will often fill in critical details which they are less inclined to share on paper.
  • 7. PATIENT/CLIENT HISTORIES & DIAGNOSTIIC COUNSELING Patient/Client History NOTE: The use of any number of exceptional clinical tools (e.g., Client Oriented Scale of Improvement, etc.) in the latter stages of the initial interview can also provide unique insights into patient/client needs, goals, expectations, and final HI selection criteria.
  • 8. PATIENT/CLIENT HISTORIES & DIAGNOSTIIC COUNSELING Patient/Client History Also Note: Any patient/client statements of a “diagnostic nature” should be investigated thoroughly, because they may represent their incorrect reflection of a previous diagnosis.
  • 9. PATIENT/CLIENT HISTORIES & DIAGNOSTIIC COUNSELING Patient/Client History  It is important to have a third party participate in the initial consultation.  Often a companion observation form may also be integrated into the interview. This can often clarify the impact of the hearing loss.
  • 10. PATIENT/CLIENT HISTORIES & DIAGNOSTIIC COUNSELING Diagnostic Counseling  In the important area of content counseling, it is helpful if the type and degree of hearing loss are explained with the goal of all involved acquiring a basic understanding of the audiogram.  A sensible approach, after completing the testing, is to simply ask what information is desired.
  • 11. PATIENT/CLIENT HISTORIES & DIAGNOSTIIC COUNSELING Diagnostic Counseling The audiogram results should be explained in as much detail as the patient/client desires, using the clearest terms possible with conscious avoidance of audiological jargon.
  • 12. PATIENT/CLIENT HISTORIES & DIAGNOSTIIC COUNSELING Diagnostic Counseling  When discussing test results, dispensing professionals should not be separated by desks and tables.  It should be noted--as the physical space between parties is decreased, the opportunities for trust and openness increase.
  • 13. PATIENT/CLIENT HISTORIES & DIAGNOSTIIC COUNSELING Diagnostic Counseling  The dispensing professional must not engage in discussions regarding acoustic tumors, etc.  A suspect medical condition should be referred to the physician with a confidence level—not professional suspicions of what might be found.
  • 14. PATIENT/CLIENT HISTORIES & DIAGNOSTIIC COUNSELING Diagnostic Counseling  When making a referral, simply state that the tests reveal a necessity for additional investigation by another healthcare provider.
  • 15. PATIENT/CLIENT HISTORIES & DIAGNOSTIIC COUNSELING Diagnostic Counseling  Often the professional does not realize that their choice of language, verbal and nonverbal, and even the amount of information provided , may have profound effects, both positive and negative, on the receiver of that information.
  • 16. PATIENT/CLIENT HISTORIES & DIAGNOSTIIC COUNSELING Diagnostic Counseling  Care should be taken not to present more information than can be taken in.  On the initial confirmation of hearing loss, emotions can be quite “sensitized”.  This often makes the cognitive processing of new information limited at best.
  • 17. PATIENT/CLIENT HISTORIES & DIAGNOSTIIC COUNSELING Diagnostic Counseling  It is wise to “pace” the delivery of information, possibly withholding details until a subsequent visit, while always questioning the patient/client to assess their comprehension and emotional reaction to the results/news being provided.
  • 18. PATIENT/CLIENT HISTORIES & DIAGNOSTIIC COUNSELING Diagnostic Counseling Please NOTE: When results discussions regarding the patient/client are directed solely to others in attendance; the patient/client will resent being ignored and will rapidly feel a level of marginal importance towards their rehabilitative process.
  • 19. PATIENT/CLIENT HISTORIES & DIAGNOSTIIC COUNSELING Diagnostic Counseling  It has been inferred that adults receiving news of their permanent hearing loss do not suffer significant shock, disappointment, anger, sadness, or other emotions.  However, in many cases, this is far from true.
  • 20. PATIENT/CLIENT HISTORIES & DIAGNOSTIIC COUNSELING Diagnostic Counseling  Some adults receive what they perceive to be “bad news” about irreversible hearing loss in a matter-of-fact way.  Other adults receive the same “bad news” and perceive it as “catastrophic”.
  • 21. PATIENT/CLIENT HISTORIES & DIAGNOSTIIC COUNSELING Diagnostic Counseling  It is almost always desirable to ask new adult patients to be accompanied to their hearing evaluations by someone significant to them, such as a spouse.  The support and the clinical insights gained through such a practice can be immeasurable.
  • 22. PATIENT/CLIENT HISTORIES & DIAGNOSTIIC COUNSELING Diagnostic Counseling  The patient/client must not feel overwhelmed with too much information.  Too many treatment/management options can create confusion resulting in a patient/client choosing to postpone or delay treatment.
  • 23. PATIENT/CLIENT HISTORIES & DIAGNOSTIIC COUNSELING Diagnostic Counseling  When presenting diagnostic information, the dispensing professional must temper their enthusiasm for launching rehabilitative efforts with patience and understanding.  It is frequently the unasked questions by the patient/client which must be “sensed” and “answered”.
  • 24. PATIENT/CLIENT HISTORIES & DIAGNOSTIIC COUNSELING Diagnostic Counseling  It is the dispensing professional’s responsibility to recognize and accept conditions that may affect their patient/client decisions.  Always be prepared to explore with them various means that may help them recognize the value of alternative viewpoints and actions.  This is often accomplished by reflecting patient/client concerns back to them.
  • 25. PATIENT/CLIENT HISTORIES & DIAGNOSTIIC COUNSELING Diagnostic Counseling  Effective reflections come in lead statements such as: ”I understand what you are saying... or, more simply, “In other words...  This provides the patient/client with the opportunity to understand that you are truly concerned and empathize with their condition/situation.
  • 26. PATIENT/CLIENT HISTORIES & DIAGNOSTIIC COUNSELING Diagnostic Counseling  Patient/clients are entitled to a concerned compassionate professional who is willing to give sufficient time and express appropriate interest in what, to many people, is a profound and disturbing disability.  Counseling beyond just an information transfer should be an integral component to the professional services offered.