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Communication Smarter Way.

Communication Smarter Way.






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    Communication Smarter Way. Communication Smarter Way. Presentation Transcript

    • Communication Smarter way. Ref : Family practice Management.May 1999 Interpreted by Rajeev Kashyap
    • Time constrain in Clinical research visit
      • Research documenting are time lined and demanding
    • Always start with the standard questions applied to the chief complaint(s):
      • Location
      • Radiation
      • Quality
      • Quantity
      • Duration
      • Frequency
      • Aggravating Factors
      • Relieving Factors
      • Associated Symptoms
      • Effect on Function
    • Primary History
      • Repeat this series of questions for each chief complaint. Ask one question at a time; avoid multi-part questions.
      • Some questions won't work in certain situations, for example fatigue doesn't have a location.
      • Record the information as objectively as possible without interpretation. Avoid medical jargon unless the patient uses it.
      • Quote the patient directly as needed, "my nose itch," for example.
    • Major Components
      • 1. Patient Identification (ID)
      • 2. Patient Profile (PP)
      • 3. Chief Complaint (s)
      • 4.the reason(s) Why the patient sought medical advice?
      • Review of Systems
    • History taking AIM
      • The aims of history taking are threefold:
      • To identify the relevant organ system(s) responsible for symptoms
      • To clarify the nature of the pathological processes at play
      • To characterize the social context of patients’ illness, their concerns,their interpretation of symptoms, beliefs and attributions and any limitations of daily activities consequent upon their illness.
    • Diagnostic information
      • The key to reaching an accurate diagnosis is obtaining a detailed description of the patient’s symptoms. Every individual symptom suggests a differential diagnosis which may initially be wide ranging but can be brought into sharper focus by obtaining as much detail as possible.
    • Approach to the patient
      • You will feel intimidated in your first attempts at history taking.
      • Try to be caring and compassionate but remember that you are not directly responsible for your patient’s medical care.
      • Introduce yourself with a friendly greeting, giving your name and status.
      • Explain the purpose of his/her visit, ask for and remember the patient’s name and request permission to interview and examine the patient.
    • Factors in establishing rapport
      • Introduce yourself in a warm, friendly manner.
      • Maintain good eye contact.
      • Listen attentively.
      • Facilitate verbally and non-verbally.
      • Touch patients appropriately.
      • Discuss patients’ personal concerns.
    • History Taking Techniques
      • Adopt a personal, conversational style rather than an interrogative approach and don’t confuse patients with medical jargon.
      • When asking specific questions relating to symptoms, avoid leading questions which might compromise the quality of information obtained.
    • History Taking Techniques(Cont.)
      • LISTEN:Allow patients to tell the story in their own words Encourage their flow with verbal and non-verbal cues Try not to interrupt
      • CLARIFY:Exact nature of vague terms or lay terms ,Timing of events
      • Apparent inconsistencies or gaps in the story.
      • QUESTION:Specific areas of relevance Use open questions initially
      • Avoid leading questions
      • SUMMARISE:Outline the story as you understand it Invite patient to correct inaccuracies
    • Top ten technique tips
      • Give the patient your undivided attention
      • Keep your note-taking to a minimum when the patient is talking
      • Use language which the patient can understand
      • Let patients tell their own story in their own way
      • Steer patients towards the relevant
      • Use open questions initially and specific (closed) questions later
      • Clarify the meaning of any lay terms or diagnoses patients use
      • Remember that the history includes events up to the day of interview
      • Summarize (reflect back) the story for the patient to check
      • Utilize all available sources of information
    • History taking Sequence
      • one effective and commonly used sequence
      • comprises:
      • Introduction
      • Presenting complaint
      • History of current illness
      • Systemic enquiry
      • Past medical history
      • Drugs and allergies
      • Family history
      • Social and personal history
      • Patient’s ideas, concerns and expectations.
    • Introduction
      • Introduce yourself to the patient giving your name
      • Ask the patient’s name,
      • Ask for permission to take a history
    • Presenting complaint
      • the principal symptom or symptoms that caused the patient to seek medical attention, when it first appeared and how it has changed over time.
    • Patient’s account
      • When did you last feel fit and well?
      • • When did you first notice a change in your usual state of health?
      • • What was the first symptom you noticed?
      • • When was that and what has happened since?
      • • What else have you noticed about your health?
      • • What has happened to you since you came into hospital?
      • • How do you feel at the moment?
    • History Taking
      • Record the presenting complaint in the patient’s own words,
      • the date and time of its first occurrence and
      • if the problem has changed in any way since its onset.