Cs - counseling dialogue..

[vsmedic]

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Keeping the counselling short, could someone whose already taken it advise me if the following is ok for smoking/alcohol couselling:

Mr/Mrs. so and so, smoking is bad for you're health. When you're ready to quit, please let me know and I can help you with that.

Also,
When a pt is asked if he has any urinary complaints, will he volunteer if he has increased urination or pain or such, or should he or she be specifically asked of increased urination?

Any advice would be great, thanks

Good luck 🙂

 

[Depakote]

Keeping the counselling short, could someone whose already taken it advise me if the following is ok for smoking/alcohol couselling:

Mr/Mrs. so and so, smoking is bad for you're health. When you're ready to quit, please let me know and I can help you with that.

Also,
When a pt is asked if he has any urinary complaints, will he volunteer if he has increased urination or pain or such, or should he or she be specifically asked of increased urination?

Any advice would be great, thanks

Good luck 🙂

For smoking, mine was something like:

(if patient smokes, after asking how much, etc)

Have you thought about quitting?

if yes: Great. Well lets set up an appointment when you leave and we can talk about that at your next visit.

if no: Ok, well when you're ready let us know and we'll be more than happy to help you with it.


As for urinary complaints, it would depend on what the CC was.

If the patient was in for a CC of dysuria, then you should ask very detailed questions about urinary symptoms (hesitancy, frequency, urgency, blood, etc).

If the patient was in for a CC of sore throat, you can probably just ask if they've had any "urinary symptoms" or "problems with their bladder" during your ROS and then follow up any positive answers with more detailed questions. They know you're on a timeline... they don't expect you to ask every possible unrelated symptom.

 

[Golding]

I agree with Depakote's script. Smoking is bad for the health, but everyone in the US has heard that by now. It's a consumer choice that has to be prompted with "Have you ever thought about cutting down on smoking?"

Everyone I asked said yes, which was relieving. It's a lot smoother to say that you can help them get on the path to quitting. But if they say no, then the "If you ever do decide that you do want to cut down, please let me know and I can help you out with it." line is just fine.

And indeed, unless they mention any specific urinary issues, you can cover the urinary stuff with "Any changes in the urine?" If the actor thinks you're being too broad, they might ask "Like what?", and then you can specify a little more.

 

[mumd2011]

I think approaching smoking (and, you can do this with drinking alcohol as well) with the "are you thinking about quitting?" is the best way to do it. Then, it makes it much easier to just do the whole "I am happy to hear that, it will benefit your health greatly, and we can set up a follow-up appointment to discuss it further" scenario.

Another thing to remember is sexual health. I have heard/and had several patients who weren't practicing safe sex. After asking about their sexual history and contraceptive use/STD testing (which if it is a female-you could also ask during Ob/Gyn Hx), if they did not use condoms, I would go into the "the use of condoms is very important to protect yourself against diseases that are spread through sexual contact and I encourage you to use condoms whenever you engage in sexual activity." You may also have a patient that says that they are no longer worried about pregnancy and that is why they don't use condoms anymore (this is probably fine if they are in a monogamous relationship-which you also should ask about) but, in some cases, you may need to also stress that condoms aren't just for pregnancy prevention, etc.

The counseling part of this test is what is so frustrating. I think it is safe to say that if someone comes in and is having acute chest pain, exacerbation of COPD, meningitis, etc. (the common cases on CS) then you would deal with the acute issues first and save the really detailed history for a little later unless it would directly affect your diagnosis.

Also, be careful of asking the "any problems/changes with urination" question. I know that these SPs are trained to only answer direct questions and may look at you strangely or give you an answer that isn't really what you wanted. I asked "have you noticed in changes in the frequency of urination" "have you noticed any red urine" and "does it hurt when you urinate." If the CC wasn't a urinary complaint or something that could be related to the GU system, then I stopped there. I think it is safe to say that ROS should be as quick as possible but somewhat thorough. Plenty of people fail this exam because they rushed through and only asked the bare minimum.

 

[ShyRem]

Along with the "we'll set up an appointment" I also added "we have some literature on the different options on methods and medications to help you quit. I'll make sure you get those on your way out so you have time to read it and we can talk about any questions you have at your next appointment."

 

[vsmedic]

thank you for all the replies 🙂 really gives me a good idea of what to say during counseling.
as i right this , I have another question come to mind..

as far as the closure goes, does it have to be my first two differential diagnosis i tell the pt?

also, do the diff diagnosis and workup be arranged in order of most important from 1 to 5?

always grateful for the replies. thanks

Goodluck

 

[Depakote]

thank you for all the replies 🙂 really gives me a good idea of what to say during counseling.
as i right this , I have another question come to mind..

as far as the closure goes, does it have to be my first two differential diagnosis i tell the pt?

also, do the diff diagnosis and workup be arranged in order of most important from 1 to 5?

always grateful for the replies. thanks

Goodluck

When closing with the patient, I didn't always have a 100% idea of what I was dealing with. (occasionally this came to me when typing up my note)

I usually went with something sufficiently vague, but informative.

(going with my randomly selected sore throat example above)
"I think your sore throat is probably due to a viral illness, but I'd like to get a few more tests. I'm going to get a throat culture. I'd also recommend that you consider quitting smoking as this is one thing that you can do to help your overall health.

I think it's ok to recommend things like staying hydrated, symptomatic treatment, etc. I don't think they want you want to go too far into recommending specific treatments for patients during your closing. Patients may have questions for you during your closing. Nothing too tough, just make sure to save time for it.

edit: when typing up your note, try to put things in order from most to least important (this includes ddx and labs)... so if you really need a CBC on a patient, put that first. If you think a MRI might be nice, but you are more doing it to confirm the dx and show that you know you use MRI to r/o XYZ disorder in a patient with whatever complaint, put it last.