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Medical interview how would you change healthcare keepingyouwell adventist health system physicians

Medical interview how would you change healthcare

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Another example of a healthcare-related weakness is an inability to multitask well. Healthcare professionals must juggle many tasks at once, and not being able to do so efficiently can lead to errors. If you have healthcare experience in clinical settings, highlight how professionals must focus on patient safety and best practices to keep patients healthy.

Sample answer: "I'm a perfectionist, which affects my ability to delegate tasks and let go. However, I am working on improving this by utilizing some of my time-management skills I discussed earlier. This healthcare interview question aims to identify how you can contribute to an organization and connect your healthcare career goals with the organization's objectives.

You can choose to discuss innovations or industry challenges. First, research the company thoroughly and understand its healthcare initiatives in addition to changes that could impact the industry as a whole. Next, know the community you serve. Then, demonstrate your understanding of a healthcare environment by sharing your thoughts and views on recent developments and how they will impact the future of healthcare. For example, if you're looking for a job in research, talk about specific trends and how clinicians may enhance outcomes by conducting studies.

Finally, emphasize what you would do to contribute to industry changes and how these changes will positively impact healthcare in your community. Sample answer: "As industry experts, we are often encouraged to stay up-to-date with the latest healthcare initiatives. I anticipate healthcare organizations will play an integral role in delivering healthcare by focusing on patient satisfaction and providing resources through diverse technologies.

Just as with the previous question, this one presents an opportunity to highlight your knowledge and awareness of healthcare advancements and issues. Instead, try to speak specifically about healthcare advancements and issues you follow or understand. If anything, you can turn industry trends into your interview edge.

Describe healthcare-related magazines, journals and programs that you follow in addition to any other related news outlets. Sample answer: "I like to read healthcare blogs with updated information and industry news. I am also a member of healthcare organizations on LinkedIn, which has helped me stay up-to-date with the latest healthcare advancements. Need more help? University of Phoenix career advisor Jason Robert shares his 5 tips for preparing for a successful interview.

Click here or on the image below to watch the video. Employers typically ask this question to see what motivates you and how you would fit in as an employee of the healthcare organization. Answering healthcare interview questions about your motivations requires that you show dedication and desire.

In addition, during the interview, you must connect your motivation to healthcare advancement and research so hiring managers know you share their vision and understand what drives employers. While it may be tempting to give a generic answer, questions like this require you to dig deeper and show the interviewer what motivates your career choice.

Sample answer: "I chose healthcare as a profession because I've always been curious about healthcare and how it impacts people at their most vulnerable times. I want to make healthcare more accessible and convenient for those who truly need it. Wondering what it takes to succeed in healthcare? While healthcare interview questions like this may seem simple, your response can tell the interviewer just how professionally you handle sensitive situations. Regardless of how difficult patients can be, healthcare professionals must learn to remain calm and patient when dealing with others' healthcare concerns.

The best answer is one that demonstrates your ability to be empathic and understanding of concerns while defusing any tension. Making a strong, supportive connection early on will help achieve this. Sample answer: "I understand healthcare is often a sensitive topic for many people, so I am careful about how I approach patients and their questions or concerns. Overall, I have learned to take a step back in order to understand what a given issue might be. By doing this instead of jumping into action, I'm able to deliver better care.

A question like this checks your interpersonal skills and ability to deliver healthcare information professionally. The best answers include empathy and understanding of how healthcare-related situations may impact patients, family members and other loved ones. In addition, the interviewer will be looking for your ability to support patients through their decisions. Sample answer: "I focus on gathering all the correct clinical information to be ready to answer any questions.

Next, I offer sincere apologies and explain the healthcare situation in easily understandable terms. Finally, I always offer an opportunity for healthcare questions and answers before leaving the room. This interview question is designed to reveal if you understand the organization and company culture. You should demonstrate your ability to think critically, acknowledge what makes you an asset to healthcare organizations, and communicate how your skills will benefit the company.

Your flexibility is also good to highlight. Acknowledge your willingness to do this if necessary. Focus on your strengths and how they meet or exceed employer expectations. You must learn about the healthcare company to provide an answer that will encourage it to hire you. An excellent way to begin your response is to speak about the organization's vision and goals. Sample answer: "I am confident I can add value to this organization through my highly developed skills and experience. I'm excited about this opportunity because of the organization's strong focus on empathy and patient care.

In addition, my previous experience with ABC Clinic has taught me valuable communication, time-management and decision-making skills. I feel confident I can positively contribute to this healthcare organization. Some healthcare organizations value your desire to achieve specific healthcare goals and long-term plans, and they look for ways to help you achieve them. There is no need to go into detail about your life plan.

Instead, concentrate on the short term, and discuss how the employer is a part of your objectives. Sample answer: "My short-term goal is to secure a position as a physician assistant. Ultimately, I'd like to further my career by working for a company such as this one in the capacity of an administrator overseeing healthcare operations. Hiring managers want employees with a keen sense of responsibility and dedication. Highlight a specific situation where you went above and beyond, such as taking the lead in an emergency or returning to work after hours.

Additionally, discuss how your work has positively impacted a patient and how you accomplished your duties. Sample answer: "We had a patient who experienced chest pain and arrived at the emergency room without identifying any medical history. I stayed after my shift to gather more information, including calling her family members for medical history. I grew up in a multicultural neighborhood, so I am used to communicating with people who speak different languages. In my last role, I worked with many Spanish-speaking patients.

I learned some basic phrases to help me communicate with them more effectively. This question can help the interviewer get a better idea of how you make decisions and what your thought process is.

When answering, try to describe a situation where you made an informed decision that turned out well. They were very upset about their diagnosis and wanted to know if there was any way they could avoid chemotherapy treatment.

So, I told them we would revisit the topic after they had some time to think about things. Agile is a software development methodology that focuses on creating and implementing solutions quickly. I find that it helps me stay organized and focused while still allowing me to make changes or additions to my projects as needed.

In my last position, I helped implement Agile into our team workflow. We found that it allowed us to create better solutions for our clients. This question can help an interviewer understand how you handle conflict and challenges.

It can also show them how you apply your problem-solving skills to a situation. When answering this question, it can be helpful to think of a time when you faced a challenge with a customer or client and were able to resolve the issue in a positive way.

I met with them one-on-one to discuss their concerns and explain our reasoning for some of our decisions. We talked about alternative options and ways they could improve their health. By the end of the conversation, they seemed much happier and agreed to follow through on our recommendations.

Working in a team environment is an important skill for healthcare professionals. Employers ask this question to see if you have experience working with others and how well you collaborate.

When answering, think of a time when you worked on a project or task with other people. Explain what your role was and how it helped the group achieve its goals.

We all had different roles but also collaborated on many tasks. For example, I would help one of the other nurses with patient care while the physician examined them. Then we would switch so that each person could do their job. This allowed us to work more efficiently and provide better care for patients. This question is a great way to see how you respond to failure. I was excited to work on this project because I thought it would help me advance my career.

I felt embarrassed by my mistake but learned to double-check projects before presenting them. This question is a great way to see if the candidate has experience with coding languages. NET before in my previous role as an IT specialist.

I also had to make sure that all of our software was up-to-date and compatible with the latest operating system.

Employers ask this to see how honest you are with yourself and others. This has led to me getting sick from overworking myself on occasion. This question can help an interviewer understand how you handle conflict and disagreements. It can also show them how you work with others, as well as your communication skills. When answering this question, it can be helpful to think of a specific situation where you disagreed with your manager but were able to respectfully express your opinion.

She was happy to hear my input and we worked together to find a solution that would work for everyone. Customer service is an important part of working in healthcare.

The interviewer may ask this question to learn more about your customer service skills and how you would apply them to the role. Use examples from your experience that show you understand what it means to provide excellent customer service. When I worked as a receptionist, I often had to answer phones and help patients find their way around the office.

I always made sure to speak clearly and kindly so they could understand me. If they were upset or frustrated, I tried my best to calm them down and make them feel comfortable.

This helped many patients feel better and gave them confidence in our company. This question can help the interviewer determine your level of experience with medical billing software. If you have no prior experience, you can talk about how you would learn to use it and what resources you might use to do so.

If you have some experience, you can discuss that in detail. I could research online which software is best for a specific hospital or clinic and then learn how to use it once hired.

This question is a way for the interviewer to assess your willingness to do administrative work.

Think, barriers to change in healthcare settings with you

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They communicate the physician's respect for the patient as a unique individual. Feelings of anxiety are common during the initial moments of the encounter and may be particularly intense for the beginning student who is uncertain of his or her role. A simple statement is usually a good way to start. Hello Mrs. Parish, my name is John Simmons. I am a second year medical student here at the school. I will be interviewing you for about 30 minutes to learn what kinds of problems you are having and how they have affected you.

Will this be O. This introduction establishes names, roles, purpose including an interest in the patient's response to illness and the time limits of the interview. Of course, it is important to knock before entering the patient's room to begin the interview. Unfortunately, this courtesy is often neglected during hospital rounds. Assessing the patient's comfort is the next step. An IV or oxygen mask, facial expressions of distress, or an emesis basin at the bedside provide nonverbal clues to the alert clinician.

Bringing a cup of water, raising the head of the bed, or helping the patient to the bathroom may be greatly appreciated. They also provide a natural opportunity for a caring touch. Questions such as "How are you feeling? It is best to conduct the interview in a quiet and private environment. This may be impossible in a busy hospital. However, televisions can be turned off, doors closed, and curtains pulled.

The bedrail should be lowered to remove this physical barrier to communication. If the patient feels well enough, it may be best to help him or her into a chair. The difference between interviewing a patient who is lying flat in bed and one who is sitting in a chair can be striking. This simple act can emphasize patient autonomy and active involvement in the interview. If family members or other visitors are in the patient's room, the physician should introduce him- or herself to all those present and explain the purpose of the interview.

If they are allowed to stay, the interviewer should inform the family that the patient must be given an opportunity to speak without excessive interruptions or editorial comments. If family do not comply, this problem must be addressed directly. The first minutes give the observant physician valuable information about the patient's communication style and behavior, as well as providing a tentative list of problems. Some patients need considerable prompting to discuss their current problems, while others need limits set because of a rambling history.

The patient's vocabulary and clarity of expression can be assessed early in the encounter. Emotional reactions such as anxiety, defensiveness, or hostility are often evident. All these elements are important in determining the patient's reliability as a historian. By recognizing the patient's emotions and responding to them in a supportive manner, the clinician can conduct an effective patient-centered interview.

As examples, the interviewer will expect the confused patient to give a confused history; the emotionally reactive patient to embellish and exaggerate symptoms or reactions; and the depressed patient to be withdrawn and require considerable support.

With introductions completed and patient comfort assessed the physician must decide how to initiate further questioning. Some physicians like to ask about the patient's social and personal background, including residence, employment, and family.

Although this technique works well with some patients, others find it distracting. They seem to expect a more direct inquiry about their health and current problems. Frequently used opening questions include, "What problems brought you to the hospital or office today? At this point in the interview it is important to let the patient talk spontaneously rather than restricting and directing the flow of information with multiple questions.

Let the patient talk freely for the first few minutes before initiating a more detailed inquiry. From Beckman's observations of internal medicine residents it appears that physicians all too frequently interrupt their patients in the first few seconds of the interview. Patients are prevented from expressing their major concerns.

These unexpressed concerns may become part of a "hidden agenda" not because the patient is hiding them but because the physician hasn"t given the patient a chance to talk. What the patient patient says first may not be the only or even the most important complaint. Premature selection of a direction for detailed questioning for example, a report of generalized fatigue can confuse or distract the patient from reporting other, perhaps more significant problems for example, chest pains and the fear of heart problems.

Beginning with directive, closed questions early in the interview communicates that the patient should remain silent until asked a specific question. The patient may feel, for good reason, that his major complaint is being ignored. The physician, in turn, may feel frustrated as direct questions lead to dead ends. In such situations, describing the patient as a "poor historian" obscures the fact that the major problem stems from the physician's premature selection of a line of inquiry before the full scope of the patient's concerns was defined and the physician's overuse of a closed question—answer interactional technique.

To obtain accurate, unbiased information, exert only as much control over the interview as is needed. The physician's task is to keep the patient talking about the illness in a productive fashion. Facilitation techniques are employed to encourage and guide the patient's spontaneous report. These include the use of posture, gesture, and words to indicate that the interviewer is interested in what the patient is saying. These techniques reassure the patient that he or she should go on speaking and provide time for the patient to think and respond.

A shared silence often helps the flow of the interview if the interviewer maintains eye contact and an interested manner. It is not necessary to come up with a question each moment the patient falls silent. Silences often help the patient reexperience emotions and provide the time needed for reflection.

Most interviewers can judge if a patient is actively thinking during the silence or needs help getting started again. Prompt the patient to continue with a spontaneous report by repeating the patient's last phrase in a questioning tone such as "… you felt short of breath? Before selecting the focus for questioning, ask, "Anything else?

Some problems will be clearly related to the chief complaint. Others are unrelated or of only possible relevance. It may become evident that the patient is most troubled by problems that the physician considers of lower priority or less urgent. For example, the patient may be most concerned about his finances, while the physician wants to learn more about the chest pain and palpitations.

In general, the clinician should briefly communicate concern for the patient's major concerns even if they do not seem to be medically significant. For example,. You have mentioned quite a few problems and we may not have time to clarify all of them now.

I can see that you are very worried about your finances. Those concerns will need further attention … and we will work on them. What I would like to do now is find out more about your chest pain and the fainting spell that you mentioned. The physician cannot assume that all of the patient's concerns will be raised early in the interview. Patients may talk about embarrassing or confidential problems when rapport and trust have been deepened.

Not infrequently, the patient brings up important issues only at the end of the encounter by stating, "Oh, by the way doctor. The clinician now explores as fully as possible the patient's major problems, following leads obtained during the discussion of the chief complaint.

The history of the present illness HPI includes all of the patient's history, both recent and remote, that is pertinent to understanding the current illness. In completing the HPI, the physician will often collect pertinent information about the patient's past history for example, a history of hypertension in a patient with stroke , the patient's family history for example, a family history of breast cancer in a patient with a breast lump , and the social history for example, domestic discord in a patient with insomnia and fatigue.

Each new piece of information is assessed for reliability, completeness, and relevance to the patient's problem. The physician should repeatedly scan the information already gathered looking for symptom complexes or diagnostic patterns. For example, the physician interviewing a year-old woman with fever, back pain, and urinary frequency would immediately consider the possibility of a urinary tract infection.

With increasing knowledge of clinical syndromes, the clinician's ability to form more complex diagnostic hypotheses improves. Each hypothesis is tested for validity with further specific questions such as, "Have you ever had a bladder or kidney infection?

Any kidney stones? Are you sexually active? Begin each line of inquiry with an open-ended question and proceed to more specific questions to fill in the gaps. Encourage the patient to provide primary data in his or her own words about the symptoms rather than provide diagnostic labels or "hearsay" from other doctors or family members secondary or tertiary information.

The patient may need coaching about what information the physician seeks. For example, the patient who complains of her "esophagitis" should be asked to describe her symptoms before the physician accepts this diagnostic label. Questions should be worded so that the patient has no difficulty understanding what is being asked. Avoid using technical terms and diagnostic labels. The interviewer's questions should indicate what type of information is requested, but not what answer is expected.

The difference between asking, "Are you having any stomach problems? Effective questions are usually simple. Avoid double-barreled questions, such as "Are you having any stomach pains or bladder problems? Engel describes seven dimensions that characterize the bodily and emotional aspects of a symptom: its chronology, bodily location, quality, quantity, setting, any aggravating or alleviating factors, and associated manifestations. In general, the clinician should gather information clarifying all seven dimensions for each area of major concern.

A directive statement may be needed to direct or coach the patient about what information is needed. Let's start at the beginning. A chronologic description provides the framework for characterizing the course of an illness.

The interviewer should obtain a chronologic report by asking when the problem first started and facilitate a continuing flow of information with questions such as "And then what happened? Questions such as, "When did you last feel really well? Ask specifically if the patient has ever had similar symptoms in the past. Chronology also includes the duration of a symptomatic episode for example, minutes for the chest pain of angina, days for the chest pain of rib fractures , its periodicity for example, the on-and-off pain of an early small bowel obstruction versus the constant pain of peritonitis , and whether the symptom has gotten better or worse over time.

The bodily location of pain or other discomfort should be defined as accurately as possible. The patient may be encouraged to indicate the location and radiation of pain using hand gestures, which also indicate how large an area is involved. Remember that the patient may have more than one pain and that multiple pains may indicate multiple disease processes.

Ask the patient to characterize and differentiate each. Most patients use analogies to describe the quality of a sensation. The pain of a myocardial infarction is often described as similar to a "vise" tightening around the chest or "someone standing on the chest.

Some patients use highly descriptive or emotion-laden terms like, "It felt like someone was stabbing me with a knife. Other patients need the interviewer's help to find descriptive language. Providing the patient with a choice of descriptions such as "Was the pain sharp or dull? The intensity of pain can be estimated on a scale of 1 to 10 or compared to another pain the patient has experienced.

The scalar method is particularly helpful in following the intensity of symptoms over time. Other examples of quantity include volume for example, the quantity of sputum expectorated in a day , number for example, the number of times the patient has lost consciousness , and the degree of impairment the patient suffers. Impairment or disability is best characterized in terms of the patient's usual daily activities, such as dyspnea with climbing stairs at home or chest pain while sweeping the floor.

Some patients minimize while others amplify the quantity or intensity of their symptoms—important indicators of emotional responses and communication styles. The setting in which the symptoms occur is often critical in developing a clear description of an illness. Hypotheses regarding the etiology of symptoms frequently evolve from an understanding of the accompanying physical, social, or emotional events that surround an episode of illness.

Initial data about what makes a symptom worse and what makes it better flows from the patient's spontaneous account. Chest tightness brought on by exertion or shortness of breath at night relieved by sitting up points to specific pathologic processes, effort angina, and paroxysmal nocturnal dyspnea. A knowledge of clinical syndromes sharpens the physician's ear for clues and provides the basis for a directed line of inquiry.

For example, the physician would ask the patient who reports the sudden onset of shortness of breath and chest pain four days after a fractured tibia if the pain was pleuritic—worsened with deep breath or cough—a symptom associated with pulmonary embolus. The clinician also collects data concerning what kinds of help the patient has sought for the symptom and types of treatments already tried, including prescribed and over-the-counter medications.

Symptoms rarely occur singly. The clinician should listen for groups of related symptoms that provide diagnostic clues about pathologic processes and involved organs. The physician might ask, "When you had the joint pains, did you notice anything else? Further clarification can be obtained later using more specific questions. Even if the patient reports no associated symptoms, the physician may decide to ask directed questions which help support or reject a given diagnostic possibility. When the patient complains of joint pains, the physician might ask, "Have you had any fevers?

Night sweats? Sensitivity to the sun? Irritation in your eyes? Negative answers, often termed pertinent negatives, may be as important as positives in defining the nature and severity of the illness.

They help "rule in" or "rule out" specific diagnoses. Several other dimensions should be pursued in a comprehensive interview, including the patient's emotional reactions to the illness and the patient's means of coping with discomfort and disability.

The patient's reactions to events are often as important as the events themselves. In addition, the patient's thoughts and fantasies about what may have caused the illness are important in understanding why, when, and from whom the patient decided to seek care.

The majority of illness episodes are treated outside the physician's office. In both the problem-oriented and the health promotion interviews it is interesting to ask why the patient decided to seek care now.

Patients often have specific, perhaps unrealistic, fantasies about what the physician will or can do. The interviewer should try to identify these.

The patient's explanatory model of illness, differing with each patient and with each cultural group, may significantly determine an individual's behavior during an illness and affect compliance with medical therapy. Negotiation may bring doctor and patient closer together Kleinman et al. The interviewer uses clinical discretion in determining when the history of present illness has been clearly defined. Summarizing the history is a useful way of concluding this section of the interview. Last March you first noticed …" This summary gives the patient a chance to check the accuracy of the history and gives the physician a chance to review the history for gaps or lack of clarity.

Of course, new information may appear at any time. During the remainder of the interview, the physician directs the patient to fill in the blanks, completing the rest of the history. Before proceeding with each new section, make a clear transitional statement.

For example, "I think I"ve got a pretty good idea of your major problems and how they have developed. Now I would like to ask you some questions about your past health. A review of past medical problems and treatments not directly pertinent to the HPI completes the past medical history. A prior diagnosis of diabetes mellitus in a patient with a gangrenous toe belongs with the HPI, whereas a remote appendectomy does not.

The past medical history defines a data base for future reference. Major elements of the past medical history include childhood and adult illnesses, operations, trauma, allergies and drug sensitivities characterized in detail , immunizations, and health maintenance for example, PPD status and whether or not the patient performs a breast self-examination, has routine pap smears or sigmoidoscopies.

Medical problems in family members should be reviewed with special attention to heritable disorders. Furthermore, the patient's reaction to an illness in the family may influence response to personal medical problems.

A family history of hypertension and myocardial infarction would be included with the HPI of a patient with new-onset chest pain.

Time limitations may preclude a detailed inquiry into the health of each family member. Use discretion if the family is very large, and, in elderly patients, remember that the major purpose of the family history is to assess risk factors for the patient's current and future health.

The physician collects personal data about the patient to complete the patient profile. Much of this information will have emerged as the patient describes his story of the present illness but gaps are often apparent. Again, relevance to the patient's health and life adaptation guide the interviewer in deciding how much information to gather.

Before concluding the interview, the physician should complete a symptom checklist to assure that all important areas of the patient's physical and psychologic health have been considered.

Some clinicians prefer to complete the review of systems while examining the patient but this may be distracting for the beginning student. Begin the review of systems with an open-ended question such as "Are you having any other problems that we haven"t discussed? A transitional statement prepares the patient for the next line of questioning. Stop me if you are having one of these problems, and we will find out more about it.

Questions such as "Have you ever had headaches? Try providing direction and limits with the following. Have you had any severe headaches recently? Some patients have a "positive review of systems"—problems in every area. This may indicate emotional problems that cause the patient to amplify symptoms and use them to gain attention and emotional support.

Before closing the interview ask the patient if there is anything else he or she would like to discuss or if there are any questions. The clinician then proceeds with the physical examination. Interestingly, some patients become quite talkative during the examination.

They seem reassured by the physician's touch and may feel more at ease than when sitting face to face during the interview. Examination of a specific body region or system may remind the patient of previously forgotten details of considerable diagnostic importance. The alert physician will take the stethoscope from his or her ears long enough to hear what the patient has to say. Communication techniques are of critical importance as the physician reports the findings of the history and physical examination.

Diagnostic and prognostic discussions are most effective if tailored to the patient's individual cognitive and communication style. Special emotional concerns discovered during the interview can guide a sensitive approach to sharing news and preparing for the future.

The physician's knowledge of the patient as a person provides the foundation for patient education. In a very real sense the interview continues throughout the clinical encounter. Even the most skilled clinician may encounter problems interviewing patients. For the interview to get back on track, the clinician must recognize the problem and must find a solution. Interviewing problems can be roughly divided into three categories:. Given the complexities of the interviewing process, problems from more than one category are often found in one encounter.

The first step in solving problems is to recognize that the interview is not going well. Recognition is facilitated if the clinician assesses the interview in reference to its two major functions: data gathering and establishing a supportive therapeutic relationship. Have I collected enough data to make accurate diagnostic hypotheses about the patient's problems?

The clinician also monitors his or her own reactions to the interview. Frustration, anger, or boredom may signal a troubled interview. Once a problem is recognized, the interviewer uses clinical reasoning to establish the nature of the problem and what may have produced it.

The effort to diagnose problems in the interview parallels the process of diagnosing the patient's presenting problems or chief complaint. Like all diagnostic processes, defining the problem is based on observations of what the patient says, and how the patient says it. The clinician must "step back" mentally to form hypotheses about what is going wrong in the communication process.

For example, the interviewer may notice that the patient appears depressed and withdrawn, or perhaps confused. It may become evident that the interviewer feels negatively about the patient, disapproves of his or her behavior, or has been distracted by personal thoughts. After the problem is recognized and hypotheses generated about its etiology, the clinician tries out solutions as the interview progresses. A more complete mental status examination may be needed with the confused patient along with a decision to interview the patient's family to check for reliability of the history.

An interpreter may be needed if there is a language barrier. A less directive interview style may be required if the patient's problems have yet to be identified. A more limiting technique may be employed if the patient rambles. Clarifying and highly directed questions may be needed if the history is vague. Cultural differences may be detected and a shared approach negotiated.

The physician's limitations may be defined if the patient makes unreasonable requests Quill. Frequently, problems in the interview result from the patient's emotional reactions to illness and the medical encounter. Most patients experience considerable anxiety about their illness and about visiting the doctor. Other patients will have feelings of anger or helplessness. Responses vary with the severity of illness, past experiences, personality, current stresses and supports.

The patient who appears reticent to talk may need emotional support. Active, non-judgmental listening demonstrates the physician's interest and concern and encourages the patient to go on talking. Reassurance may be provided as the interview proceeds in an attempt to reduce the patient's anxiety. Statements such as "Anyone would be upset if they didn"t know what caused their pain" or "Waiting for biopsy results is pretty tough for most patients" may increase the patient's self-esteem and let him or her know that it is all right to share experiences with the physician.

Avoid false reassurance— the unrealistic promise of a happy outcome. To obtain accurate information about emotion-laden issues, the physician may need to "roll out the carpet," inviting the patient's honest answers. Patients often respond defensively to questions such as "How much do you drink? Rephrasing the question in a less accusatory tone provides reassurance and an atmosphere of acceptance. Have you ever experienced that? Has this been a problem for you?

Empathy is closely related to reassurance. Empathic statements communicate the physician's recognition of the patient's feelings and provide feedback that the interviewer understands. Objective 1 — Increasing access to healthcare services : The first objective of the ACA is to ensure that more Americans are able to see a doctor, get medicines, get surgery, have medical tests, and receive other healthcare services. Broadly speaking the way the ACA achieves this is by increasing the number of people who have health insurance.

The specific mechanisms through which it increases insurance coverage are as follows:. Objective 2 — Reducing healthcare costs: The second goal of the ACA is to reduce the costs of health care. There are two important mechanisms through which the ACA achieves this:. To learn more about how you can prepare for your medical school interview or to get assistance, call or email us today: or info admissionshelpers.

Disclaimer: The information provided here about the affordable care act is highly simplified. Facebook Twitter. Look No Further. Get Started Today.

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The clinician should listen for groups of related symptoms that provide diagnostic clues about pathologic processes and involved organs. The physician might ask, "When you had the joint pains, did you notice anything else?

Further clarification can be obtained later using more specific questions. Even if the patient reports no associated symptoms, the physician may decide to ask directed questions which help support or reject a given diagnostic possibility.

When the patient complains of joint pains, the physician might ask, "Have you had any fevers? Night sweats? Sensitivity to the sun? Irritation in your eyes? Negative answers, often termed pertinent negatives, may be as important as positives in defining the nature and severity of the illness.

They help "rule in" or "rule out" specific diagnoses. Several other dimensions should be pursued in a comprehensive interview, including the patient's emotional reactions to the illness and the patient's means of coping with discomfort and disability.

The patient's reactions to events are often as important as the events themselves. In addition, the patient's thoughts and fantasies about what may have caused the illness are important in understanding why, when, and from whom the patient decided to seek care.

The majority of illness episodes are treated outside the physician's office. In both the problem-oriented and the health promotion interviews it is interesting to ask why the patient decided to seek care now. Patients often have specific, perhaps unrealistic, fantasies about what the physician will or can do. The interviewer should try to identify these. The patient's explanatory model of illness, differing with each patient and with each cultural group, may significantly determine an individual's behavior during an illness and affect compliance with medical therapy.

Negotiation may bring doctor and patient closer together Kleinman et al. The interviewer uses clinical discretion in determining when the history of present illness has been clearly defined. Summarizing the history is a useful way of concluding this section of the interview. Last March you first noticed …" This summary gives the patient a chance to check the accuracy of the history and gives the physician a chance to review the history for gaps or lack of clarity.

Of course, new information may appear at any time. During the remainder of the interview, the physician directs the patient to fill in the blanks, completing the rest of the history. Before proceeding with each new section, make a clear transitional statement.

For example, "I think I"ve got a pretty good idea of your major problems and how they have developed. Now I would like to ask you some questions about your past health. A review of past medical problems and treatments not directly pertinent to the HPI completes the past medical history. A prior diagnosis of diabetes mellitus in a patient with a gangrenous toe belongs with the HPI, whereas a remote appendectomy does not. The past medical history defines a data base for future reference.

Major elements of the past medical history include childhood and adult illnesses, operations, trauma, allergies and drug sensitivities characterized in detail , immunizations, and health maintenance for example, PPD status and whether or not the patient performs a breast self-examination, has routine pap smears or sigmoidoscopies.

Medical problems in family members should be reviewed with special attention to heritable disorders. Furthermore, the patient's reaction to an illness in the family may influence response to personal medical problems. A family history of hypertension and myocardial infarction would be included with the HPI of a patient with new-onset chest pain.

Time limitations may preclude a detailed inquiry into the health of each family member. Use discretion if the family is very large, and, in elderly patients, remember that the major purpose of the family history is to assess risk factors for the patient's current and future health. The physician collects personal data about the patient to complete the patient profile. Much of this information will have emerged as the patient describes his story of the present illness but gaps are often apparent.

Again, relevance to the patient's health and life adaptation guide the interviewer in deciding how much information to gather. Before concluding the interview, the physician should complete a symptom checklist to assure that all important areas of the patient's physical and psychologic health have been considered. Some clinicians prefer to complete the review of systems while examining the patient but this may be distracting for the beginning student. Begin the review of systems with an open-ended question such as "Are you having any other problems that we haven"t discussed?

A transitional statement prepares the patient for the next line of questioning. Stop me if you are having one of these problems, and we will find out more about it. Questions such as "Have you ever had headaches? Try providing direction and limits with the following. Have you had any severe headaches recently? Some patients have a "positive review of systems"—problems in every area. This may indicate emotional problems that cause the patient to amplify symptoms and use them to gain attention and emotional support.

Before closing the interview ask the patient if there is anything else he or she would like to discuss or if there are any questions. The clinician then proceeds with the physical examination. Interestingly, some patients become quite talkative during the examination. They seem reassured by the physician's touch and may feel more at ease than when sitting face to face during the interview. Examination of a specific body region or system may remind the patient of previously forgotten details of considerable diagnostic importance.

The alert physician will take the stethoscope from his or her ears long enough to hear what the patient has to say. Communication techniques are of critical importance as the physician reports the findings of the history and physical examination.

Diagnostic and prognostic discussions are most effective if tailored to the patient's individual cognitive and communication style. Special emotional concerns discovered during the interview can guide a sensitive approach to sharing news and preparing for the future. The physician's knowledge of the patient as a person provides the foundation for patient education.

In a very real sense the interview continues throughout the clinical encounter. Even the most skilled clinician may encounter problems interviewing patients. For the interview to get back on track, the clinician must recognize the problem and must find a solution. Interviewing problems can be roughly divided into three categories:.

Given the complexities of the interviewing process, problems from more than one category are often found in one encounter. The first step in solving problems is to recognize that the interview is not going well.

Recognition is facilitated if the clinician assesses the interview in reference to its two major functions: data gathering and establishing a supportive therapeutic relationship. Have I collected enough data to make accurate diagnostic hypotheses about the patient's problems?

The clinician also monitors his or her own reactions to the interview. Frustration, anger, or boredom may signal a troubled interview. Once a problem is recognized, the interviewer uses clinical reasoning to establish the nature of the problem and what may have produced it. The effort to diagnose problems in the interview parallels the process of diagnosing the patient's presenting problems or chief complaint.

Like all diagnostic processes, defining the problem is based on observations of what the patient says, and how the patient says it. The clinician must "step back" mentally to form hypotheses about what is going wrong in the communication process. For example, the interviewer may notice that the patient appears depressed and withdrawn, or perhaps confused.

It may become evident that the interviewer feels negatively about the patient, disapproves of his or her behavior, or has been distracted by personal thoughts. After the problem is recognized and hypotheses generated about its etiology, the clinician tries out solutions as the interview progresses. A more complete mental status examination may be needed with the confused patient along with a decision to interview the patient's family to check for reliability of the history.

An interpreter may be needed if there is a language barrier. A less directive interview style may be required if the patient's problems have yet to be identified. A more limiting technique may be employed if the patient rambles. Clarifying and highly directed questions may be needed if the history is vague.

Cultural differences may be detected and a shared approach negotiated. The physician's limitations may be defined if the patient makes unreasonable requests Quill.

Frequently, problems in the interview result from the patient's emotional reactions to illness and the medical encounter. Most patients experience considerable anxiety about their illness and about visiting the doctor. Other patients will have feelings of anger or helplessness. Responses vary with the severity of illness, past experiences, personality, current stresses and supports.

The patient who appears reticent to talk may need emotional support. Active, non-judgmental listening demonstrates the physician's interest and concern and encourages the patient to go on talking. Reassurance may be provided as the interview proceeds in an attempt to reduce the patient's anxiety. Statements such as "Anyone would be upset if they didn"t know what caused their pain" or "Waiting for biopsy results is pretty tough for most patients" may increase the patient's self-esteem and let him or her know that it is all right to share experiences with the physician.

Avoid false reassurance— the unrealistic promise of a happy outcome. To obtain accurate information about emotion-laden issues, the physician may need to "roll out the carpet," inviting the patient's honest answers. Patients often respond defensively to questions such as "How much do you drink?

Rephrasing the question in a less accusatory tone provides reassurance and an atmosphere of acceptance. Have you ever experienced that? Has this been a problem for you? Empathy is closely related to reassurance.

Empathic statements communicate the physician's recognition of the patient's feelings and provide feedback that the interviewer understands. Empathy begins with the interviewer identifying the patient's emotional state. The following statement communicates the physician's recognition and acceptance of the patient's feelings and encourages further exploration of what is going on: "You look sad when you talk about your son.

Can you tell me more about him? It focuses attention on an aspect of the patient's feelings that has been communicated through statements or behaviors. Since the physician may point out an emotion that the patient is unaware of or defensive about, appropriate timing is critical.

The interviewer must be prepared for a hostile response or perhaps for denial. The nature of the response depends on the patient's personality and the depth of rapport that has been established. Patients often cry during the course of a medical interview. The interviewer does not have to rush in to stop the tears. It is often best to let the storm pass, providing time for the emotional release that crying provides.

The interview can then resume with gentle questioning. In general, it is good to avoid questions like "Why do you feel angry or sad about that? Can you tell me more about what has been going on? Gentle confrontation may be needed to address communication problems between physician and patient. For example, if the patient seems reticent to talk about issues that seem important, this can be pointed out as follows. I wonder if you may be uncertain about whether or not you can trust me.

The principle of sharing problems in the interview with the patient is seldom practiced but frequently effective. Clinicians often feel rushed to complete the interview and move on to other activities. Time limitations are a reality in clinical medicine, and it may not be possible to complete data collection during a single encounter.

In many settings the physician has the opportunity to go back to the patient again and again to further clarify the history. Patients can be encouraged to reflect on their memories and clarify them as much as possible before the next visit. Some patients seem unaware of the physician's time restraints. A patient's claim to a monopoly of the physician's efforts must be addressed. A dependent patient may express the wish to have more time with the doctor, especially during follow-up visits, by reporting worrisome symptoms e.

If recurrent, this behavior angers and frustrates most physicians and can jeopardize the physician—patient relationship. A gentle confrontation may be helpful in modifying this situation.

In the last few visits you have told me about worrisome symptoms right at the end of your appointment. This is a real problem for us because it doesn"t give us a chance to discuss these problems fully.

I"d like you to decide what problems you would like me to hear about before coming to your next visit. I"ll ask for the list at the beginning of the appointment. Given the length of your appointments we"ll have to decide which problems we can cover and which will have to wait until later. This statement establishes the physician's limits in a way that also encourages the patient's active participation in deciding how to utilize the scheduled time.

The selected references that follow elaborate and extend many of the concepts discussed here. The student should remember, however, that clinicians learn to conduct interviews by actually interviewing patients, and supervision can be a critical element in the educational process. Engel compared learning to interview patients with learning to play a musical instrument.

Both tasks require practice and critical, yet supportive, assessment of how things are going. A review of audio or video recordings can help the student observe and understand the interviewing process. Nowhere in the practice of medicine is self awareness more important. The learning process extends over many years.

The finest clinicians find new reasons for excitement and humility with each new patient encounter—with the challenge of each new interview. It is always good to hear a patient say, "I"ve finally found a doctor who really listens to my problems. Turn recording back on. Help Accessibility Careers. Boston: Butterworths ; Search term. Nature and Goals of the Interview Most clinicians rate the patient's medical history as having greater diagnostic value than either the physical examination or results of laboratory investigations Rich, The Problem-Oriented and the Health Promotion Interviews Medical interviews are of two basic types: the problem-oriented and the health promotion interviews Levinson, Diagnostic Functions: Process and Content The medical interview provides two categories of information unavailable from any other source: what the patient says about the illness and how it is said.

Therapeutic Tasks: Establishing a Helping Relationship The helping relationship is a cornerstone of medical care Rogers, Conducting the Interview The First Minutes—Greetings and Assuring Patient Comfort During the first minutes of the interview the physician actively sets the stage for an effective interaction.

Questioning, Listening, and Observing With introductions completed and patient comfort assessed the physician must decide how to initiate further questioning. Facilitation Techniques To obtain accurate, unbiased information, exert only as much control over the interview as is needed.

For example, You have mentioned quite a few problems and we may not have time to clarify all of them now. The History of Present Illness H. Type of Questions Begin each line of inquiry with an open-ended question and proceed to more specific questions to fill in the gaps. Characterizing the Patient's Symptoms Engel describes seven dimensions that characterize the bodily and emotional aspects of a symptom: its chronology, bodily location, quality, quantity, setting, any aggravating or alleviating factors, and associated manifestations.

Chronology A chronologic description provides the framework for characterizing the course of an illness. Bodily Location and Radiation The bodily location of pain or other discomfort should be defined as accurately as possible.

Quality Most patients use analogies to describe the quality of a sensation. Quantity The intensity of pain can be estimated on a scale of 1 to 10 or compared to another pain the patient has experienced. Setting The setting in which the symptoms occur is often critical in developing a clear description of an illness.

Aggravating and Alleviating Factors Initial data about what makes a symptom worse and what makes it better flows from the patient's spontaneous account. Associated Manifestations Symptoms rarely occur singly. Other Pertinent Aspects of a Symptom Several other dimensions should be pursued in a comprehensive interview, including the patient's emotional reactions to the illness and the patient's means of coping with discomfort and disability.

Summarizing the Hpi The interviewer uses clinical discretion in determining when the history of present illness has been clearly defined. Transitional Statements Before proceeding with each new section, make a clear transitional statement. Past Medical History A review of past medical problems and treatments not directly pertinent to the HPI completes the past medical history. Family History Medical problems in family members should be reviewed with special attention to heritable disorders.

Review of Systems R. Closing the Interview Before closing the interview ask the patient if there is anything else he or she would like to discuss or if there are any questions. Diagnosing and Solving Problems in the Interview Even the most skilled clinician may encounter problems interviewing patients. Interviewing problems can be roughly divided into three categories: Problems with the patient for example, intense emotional reactions, altered mental status, unrealistic fantasies about the doctor.

Problems with the interviewer for example, an overly judgmental attitude, too directive an approach in questioning, failure to listen to the patient. Problems with the physician—patient relationship for example, a language barrier, failure to negotiate a shared goal for the encounter. Emotional Responses: Reassurance and Empathy Frequently, problems in the interview result from the patient's emotional reactions to illness and the medical encounter.

Time Limitations Clinicians often feel rushed to complete the interview and move on to other activities. A Review of Common Problems Confusing the traditional, rigid order of the written medical history with the actual process by which information emerges during the medical interview.

Relying too heavily on directed, closed questions. This style discourages the patient's associations and spontaneous report of symptoms. Insisting that the interview must be accomplished in one session. Experienced clinicians return to the patient again and again to clarify the history.

Failure to follow basic courtesies in the interview: lack of clear introductions, ignoring the patient's comfort, and failure to establish an atmosphere of trust and confidentiality. Failure to elicit the patient's own ideas about the cause of the problem and the patient's fantasies about what the doctor will do. Conclusion The selected references that follow elaborate and extend many of the concepts discussed here. References Barsky AJ. Hidden reasons some patients visit doctors.

Ann Intern Med. The effect of physician behavior on the collection of data. Bernstein L. Bernstein RS. Interviewing—a guide for health professionals. Norwalk, Conn. Interviewing and patient care. New York: Oxford University Press, Engel GL.

What if music students were taught to play their instruments as medical students are taught to interview? Interviewing the patient. Philadelphia: WB Saunders, How much longer must medicine's science he bound by a seventeenth century world view. Menlo Park: The Henry J. Kaiser Family Foundation, Clinical problem solving: a behavioral analysis. Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Levinson D. A guide to the clinical interview. Philadelphia: Saunders, The medical interview: a core curriculum for residencies in internal medicine.

Teaching history-taking: where are we? Yale J Biol Med. Clinical hypocompetence: the interview. Quill TE. Partnerships in patient care: A contractural approach. Patient interviewing—the human dimension. Baltimore: Williams and Wilkins, The diagnostic value of the medical history: Perceptions of internal medicine physicians. Arch Intern Med. Rogers C. Characteristics of a helping relationship.

Boston: Houghton Mifflin. The Medical Interview. Chapter 3. In this Page. Related information. Similar articles in PubMed. In fact, medical schools are not the only ones asking about the ACA. PA schools, pharmacy schools, and sometimes even dental schools, like to discuss the possible implications of the new law on their profession with prospective students.

Before we get into discussing the law and covering its main components, its important to point out the following:. The information in this section will help provide you with a framework for thinking about the Affordable Care Act as you go into your interview. The Affordable Care Act has two objectives. In this section we have described those two objectives and shown how it achieves each objective:. Objective 1 — Increasing access to healthcare services : The first objective of the ACA is to ensure that more Americans are able to see a doctor, get medicines, get surgery, have medical tests, and receive other healthcare services.

Broadly speaking the way the ACA achieves this is by increasing the number of people who have health insurance. The specific mechanisms through which it increases insurance coverage are as follows:. Objective 2 — Reducing healthcare costs: The second goal of the ACA is to reduce the costs of health care.

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Medical Interview Skills Tutorials: The Complaints Process - Oxford Medical

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