How to act during an HPI?

[Arkangeloid]

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So I got in trouble with the school admins after failing to take an HPI of a standardized patient properly. While the evaluation said that I had done everything correct from a medical perspective and covered everything I needed to cover, I failed because I "did not display the proper emotions or provide consolation" when the patient talked about sad ****. The evaluator remarked that I "did not show any emotion at all."

I was confused at this, because nobody taught me what to do regarding emotional ****. All my instructor told us was to "act like you are on a date," but that is meaningless to someone who has never been on a date.

So how are you supposed to act when taking a HPI?

 

[dr zaius]

Act interested. Acknowledge their concerns. When they say I have had back for 2 weeks and can't function at work say things like "That must be difficult for you." or "That certainly is difficult to deal with." etc. Say things like "we're going to do everything we can to get you back in the game." etc.

Mainly just acknowledge their complaints and reassure them. Nod your head or something to show you're listening when they are talking. Change your facial expression appropriately. Try to show empathy. There is some acronym...NURS or something like that, I can't remember it from my patient care class 2 years ago, but it covers those things.

 

[xffan624]

So I got in trouble with the school admins after failing to take an HPI of a standardized patient properly. While the evaluation said that I had done everything correct from a medical perspective and covered everything I needed to cover, I failed because I "did not display the proper emotions or provide consolation" when the patient talked about sad ****. The evaluator remarked that I "did not show any emotion at all."

I was confused at this, because nobody taught me what to do regarding emotional ****. All my instructor told us was to "act like you are on a date," but that is meaningless to someone who has never been on a date.

So how are you supposed to act when taking a HPI?

Like a normal, compassionate human being. When they say they are in pain say "I'm sorry to hear that."... etc.. That's not one of those skills they teach in school, they kind of expect you to have some of that before you come in.

 

[falmouth]

EDIT: that was slightly rude

Just say "I'm sorry you feel so bad" every now and then and pretend like you actually mean it.

 

[deleted564496]

You need to develop your mirror neurons…. You just took neuroanatomy right?!

Seriously though, empathy. At least act like you give a damn.

 

[mulberry]

So I got in trouble with the school admins after failing to take an HPI of a standardized patient properly. While the evaluation said that I had done everything correct from a medical perspective and covered everything I needed to cover, I failed because I "did not display the proper emotions or provide consolation" when the patient talked about sad ****. The evaluator remarked that I "did not show any emotion at all."

I was confused at this, because nobody taught me what to do regarding emotional ****. All my instructor told us was to "act like you are on a date," but that is meaningless to someone who has never been on a date.

So how are you supposed to act when taking a HPI?

 

[HooliganSnail]

So I got in trouble with the school admins after failing to take an HPI of a standardized patient properly. While the evaluation said that I had done everything correct from a medical perspective and covered everything I needed to cover, I failed because I "did not display the proper emotions or provide consolation" when the patient talked about sad ****. The evaluator remarked that I "did not show any emotion at all."

I was confused at this, because nobody taught me what to do regarding emotional ****. All my instructor told us was to "act like you are on a date," but that is meaningless to someone who has never been on a date.

So how are you supposed to act when taking a HPI?

All I can think about is the thousands of qualified applicants who got rejection letters because you got their med school spot.......Seriously?!?!?

You are clearly the poster child behind the new MCAT.

If you can't handle a standardized patient then you are gonna have a problem with the Step 2 CS. Not being personable and empathetic is the most common reason for failure (after not being able to speak english)

 

[Arkangeloid]

All I can think about is the thousands of qualified applicants who got rejection letters because you got their med school spot.......Seriously?!?!?

You are clearly the poster child behind the new MCAT.

If you can't handle a standardized patient then you are gonna have a problem with the Step 2 CS. Not being personable and empathetic is the most common reason for failure (after not being able to speak english)

You're not the first person to tell me I don't deserve to be a medical student, and you won't be the last. But really, I take it as a compliment. Because if I can con (as you claim) an entire committee of highly educated people who have looked at tens of thousands of applicants over the years, I must have something going for me!

Now I would appreciate it if you could offer some constructive criticism.

 

[HooliganSnail]

You're not the first person to tell me I don't deserve to be a medical student, and you won't be the last. But really, I take it as a compliment. Because if I can con an entire committee of highly educated people who have looked at tens of thousands of applicants over the years, I must have something going for me!

Now I would appreciate it if you could offer some constructive criticism.

Go into Pathology

 

[Arkangeloid]

Go into Pathology

Actually Path was one of my favorite med school classes (besides Psych!), but I've heard the job market for that field is abysmal, so it's a no-go I fear.

 

[Elisabeth Kate]

If a man comes in for insomnia and during social history, he says his 3-year-old son was recently kidnapped and murdered, what would you say?

(a) "Wow, really? I've never known a homicide victim before."
(b) "I'm really sorry to hear that. I can only imagine what a difficult time this is."
(c) "I don't know how to talk to you."
(d) "Do you have any other children?"

 

[username456789]

If a man comes in for insomnia and during social history, he says his 3-year-old son was recently kidnapped and murdered, what would you say?

(a) "Wow, really? I've never known a homicide victim before."
(b) "I'm really sorry to hear that. I can only imagine what a difficult time this is."
(c) "I don't know how to talk to you."
(d) "Do you have any other children?"

(e) "I would have returned him safely if you would have paid your copays"

 

[mulberry]

If a man comes in for insomnia and during social history, he says his 3-year-old son was recently kidnapped and murdered, what would you say?

(a) "Wow, really? I've never known a homicide victim before."
(b) "I'm really sorry to hear that. I can only imagine what a difficult time this is."
(c) "I don't know how to talk to you."
(d) "Do you have any other children?"

amirite

 

[Arkangeloid]

amirite

Y'all are mean, I was only asking for help 🙁

 

[DermViser]

So I got in trouble with the school admins after failing to take an HPI of a standardized patient properly. While the evaluation said that I had done everything correct from a medical perspective and covered everything I needed to cover, I failed because I "did not display the proper emotions or provide consolation" when the patient talked about sad ****. The evaluator remarked that I "did not show any emotion at all."

I was confused at this, because nobody taught me what to do regarding emotional ****. All my instructor told us was to "act like you are on a date," but that is meaningless to someone who has never been on a date.

So how are you supposed to act when taking a HPI?

Assuming you're being serious, the key is to act more caring and empathetic. Perfect example: How would YOU want to be treated by a doctor, if you're seriously going to a doctor for help with a problem? Or how would you want a doctor to treat your own mother?

A doctor isn't just someone who spits out facts, information, and lab reports to the patient, esp. in this day in age where a lot of that can be Googled. It's not just throwing pills and procedures at patients. Yes, with a standardized patient it's hard to be empathetic as it's not real. Hence do what every student does here and at Step 2 CS, you act and fake it well.

On another note, congrats on getting the medical stuff right. That's the hard part, in my opinion.

 

[DermViser]

Act interested. Acknowledge their concerns. When they say I have had back for 2 weeks and can't function at work say things like "That must be difficult for you." or "That certainly is difficult to deal with." etc. Say things like "we're going to do everything we can to get you back in the game." etc.

Mainly just acknowledge their complaints and reassure them. Nod your head or something to show you're listening when they are talking. Change your facial expression appropriately. Try to show empathy. There is some acronym...NURS or something like that, I can't remember it from my patient care class 2 years ago, but it covers those things.

Honestly, if someone (not talking about you, necessarily) needs an acronym to remember how to be empathetic, they have bigger issues. Empathy isn't a mnemonic of checklist tasks, it's more an overall gestalt.

 

[CherryRedDracul]

100% serious question: do you have difficulty understanding social cues and/or have you been diagnosed with Asperger's?

Honestly, if someone (not talking about you) needs an acronym to remember empathy, they have bigger issues.

Looks like a great acronym for people with Asperger's.

 

[DermViser]

So I got in trouble with the school admins after failing to take an HPI of a standardized patient properly. While the evaluation said that I had done everything correct from a medical perspective and covered everything I needed to cover, I failed because I "did not display the proper emotions or provide consolation" when the patient talked about sad ****. The evaluator remarked that I "did not show any emotion at all."

I was confused at this, because nobody taught me what to do regarding emotional ****. All my instructor told us was to "act like you are on a date," but that is meaningless to someone who has never been on a date.

So how are you supposed to act when taking a HPI?

One time, when you're not too busy, you need to watch the movie Wit. Here it is.



Unless you're someone that has absolutely no feelings whatsoever, you'll understand after watching this, why SOME level of empathy is necessary. Patients' aren't just widgets which doctors fix up and send them merrily on their way.

 

[madchemist89]

So I got in trouble with the school admins after failing to take an HPI of a standardized patient properly. While the evaluation said that I had done everything correct from a medical perspective and covered everything I needed to cover, I failed because I "did not display the proper emotions or provide consolation" when the patient talked about sad ****. The evaluator remarked that I "did not show any emotion at all."

I was confused at this, because nobody taught me what to do regarding emotional ****. All my instructor told us was to "act like you are on a date," but that is meaningless to someone who has never been on a date.

So how are you supposed to act when taking a HPI?

Work on what the above posters have suggested, and you are going to be just fine. Interviewing is a skill. Like any other skill, you can get better at it with practice. That's why it's called the practice of medicine.

 

[DermViser]

If a man comes in for insomnia and during social history, he says his 3-year-old son was recently kidnapped and murdered, what would you say?

(a) "Wow, really? I've never known a homicide victim before."
(b) "I'm really sorry to hear that. I can only imagine what a difficult time this is."
(c) "I don't know how to talk to you."
(d) "Do you have any other children?"

I could see how some could pick (a) either due to lack of real-life experience or if they had Asperger's

 

[Arkangeloid]

100% serious question: do you have difficulty understanding social cues and/or have you been diagnosed with Asperger's?



Looks like a great acronym for people with Asperger's.

Actually my psychiatrist does suspect I have Asperger's based on a birth and developmental history, but she did not make a formal diagnosis of the disease, so I guess the answer is "no."

 

[HopefulReapp]

100% serious question: do you have difficulty understanding social cues and/or have you been diagnosed with Asperger's?



Looks like a great acronym for people with Asperger's.

I was actually wondering about this as well, in the most non offensive way possible.
A buddy of mine is a great and smart guy, but he is clinically diagnosed with aspergers and has no emotions other than basic happy and basic mad. He fakes it and many people can't tell.


Sent from my iPhone using Tapatalk - now Free

 

[DermViser]

100% serious question: do you have difficulty understanding social cues and/or have you been diagnosed with Asperger's?

Looks like a great acronym for people with Asperger's.

I was actually wondering about this as well, in the most non offensive way possible.
A buddy of mine is a great and smart guy, but he is clinically diagnosed with aspergers and has no emotions other than basic happy and basic mad. He fakes it and many people can't tell.

Name: State the patient's emotion
Understand: Empathize with and legitimize the emotion
Respect: Praise the patient for strength
Support: Show support
Explore: Ask the patient to elaborate on the emotion

 

[DermViser]

Actually my psychiatrist does suspect I have Asperger's based on a birth and developmental history, but she did not make a formal diagnosis of the disease, so I guess the answer is "no."

Asperger's is also along a spectrum of disease. Many are not "formally" diagnosed.

 

[Siggy]

Just Pavlov Dog it.

Patient: [something hurts]
Doctor: Sorry to hear that.


Patient: [something sad]
Doctor: Sorry to hear that.


Patient: [just about anything else]
Doctor: Sorry to hear that.

 

[gregoryhouse]

haha just be like dr. house, no empathy but hilariously charming 🙂

honestly though, standardized patients are kind of a weird thing imo. You have a person pretending to be sick and you have to pretend to be empathetic. Its not hard to pretend but I won't lie that when I have that class at 5 pm after a couple exams and lectures I'm a lot less interested in acting empathetic.

OP have you gone to see patients in a real clinic setting? Its a lot easier to feel empathetic with real patients because you know this is something that is actually affecting their lives and they are confiding in you. If you have problems showing empathy with real patients though, you might wanna think about why you got into medicine in the first place.

As for SP's as someone else said, fake it til you make it.

 

[DermViser]

All I can think about is the thousands of qualified applicants who got rejection letters because you got their med school spot.......Seriously?!?!?

You are clearly the poster child behind the new MCAT.

If you can't handle a standardized patient then you are gonna have a problem with the Step 2 CS. Not being personable and empathetic is the most common reason for failure (after not being able to speak english)

You think that multiple choice questions testing psychology and sociology will somehow cure this? Give me a break.

 

[@JackShephard]

Act interested. Acknowledge their concerns. When they say I have had back for 2 weeks and can't function at work say things like "That must be difficult for you." or "That certainly is difficult to deal with." etc. Say things like "we're going to do everything we can to get you back in the game." etc.

Mainly just acknowledge their complaints and reassure them. Nod your head or something to show you're listening when they are talking. Change your facial expression appropriately. Try to show empathy. There is some acronym...NURS or something like that, I can't remember it from my patient care class 2 years ago, but it covers those things.

This is good advice.

If you don't feel like you can act it out, then at least say it.

If you're good at checking things off of your medical list (HPI, PMH, SHx, FHx, etc.) Then just add a few more to your checklist:

-Say a phrase to show empathy three time during entire interview

"I can understand that would be difficult." etc.

Here's something from online, adapt it:

7 Phrases That Convey Empathy to Customers

• “I can understand how frustrating it is when your Widget breaks down.”
• “I realize how complicated it is to…”
• “I cannot imagine how upsetting it is to…”
• “I know how confusing it must be when…”
• “I’m so sorry to hear that…”
• “I hate that you had to make this call today.”
• “I’m glad you called today so that we can take care of this right away.”

 

[Siggy]

If a man comes in for insomnia and during social history, he says his 3-year-old son was recently kidnapped and murdered, what would you say?

(a) "Wow, really? I've never known a homicide victim before."
(b) "I'm really sorry to hear that. I can only imagine what a difficult time this is."
(c) "I don't know how to talk to you."
(d) "Do you have any other children?"

There's social history besides "Do you prefer alcohol, drugs, or tobacco?" [Triggers belongs in the HPI, Tiggers belongs in the psych ward]

 

[Siggy]

Name: State the patient's emotion
Understand: Empathize with and legitimize the emotion
Respect: Praise the patient for strength
Support: Show support
Explore: Ask the patient to elaborate on the emotion

Why do I suspect that's on the back of one of the cards that comes with your hospital's ID badge?

 

[DermViser]

Why do I suspect that's on the back of one of the cards that comes with your hospital's ID badge?

Uh, definitely not my badge. I googled it, as someone here mentioned a "NURSE" mnemonic for empathy.

 

[CherryRedDracul]

Actually my psychiatrist does suspect I have Asperger's based on a birth and developmental history, but she did not make a formal diagnosis of the disease, so I guess the answer is "no."

That was my hunch. Back in undergrad, I used to play AD&D with 3 guys with Asperger's, all three with slightly varying degrees of it. They told me that they basically had to learn how to interpret social cues and formulate the appropriate response. One of them, I guess, really mastered it because I had no idea he had Asperger's until he told me about it, and then I'd only catch on--in certain situations--where he'd miss some social cue. He had a cute Asian girlfriend and everything though.

 

[GadRads]

haha just be like dr. house, no empathy but hilariously charming 🙂

honestly though, standardized patients are kind of a weird thing imo. You have a person pretending to be sick and you have to pretend to be empathetic. Its not hard to pretend but I won't lie that when I have that class at 5 pm after a couple exams and lectures I'm a lot less interested in acting empathetic.

OP have you gone to see patients in a real clinic setting? Its a lot easier to feel empathetic with real patients because you know this is something that is actually affecting their lives and they are confiding in you. If you have problems showing empathy with real patients though, you might wanna think about why you got into medicine in the first place.

As for SP's as someone else said, fake it til you make it.

I agree. it's much easier and natural to show empathy for real patients. I genuinely feel bad for some of the patients I have seen and it is much easier to develop rapport with them. For SPs, I find it harder.

 

[Siggy]

Uh, definitely not my badge. Must just be your hospital. We have more important things to put on the back of our ID cards.

Pull
Aim
Squeeze
Sweep?

I swear, my home hospital badge comes with 5 separate cards with equally useless information like that.

 

[DermViser]

Pull
Aim
Squeeze
Sweep?

I swear, my home hospital badge comes with 5 separate cards with equally useless information like that.

Yup we have cards on the back of our hospital badges, what the difference codes mean: Code Blue, Code White, etc.

 

[Arkangeloid]

That was my hunch. Back in undergrad, I used to play AD&D with 3 guys with Asperger's, all three with slightly varying degrees of it. They told me that they basically had to learn how to interpret social cues and formulate the appropriate response. One of them, I guess, really mastered it because I had no idea he had Asperger's until he told me about it, and then I'd only catch on, in certain situations, where he'd miss some social cue. He had a cute Asian girlfriend and everything though.

Yeah, that's me. I mostly had to teach myself how this social **** works, and I don't enjoy any of it, I just pretend to. Maybe that's why I'm foreveralone haha.

I don't think it's atypical in medical school though. You have to be kinda craycray to pick this career, and as I found out, there are people even less sociable than me here.

I used to love Dungeons and Dragons too.

 

[CherryRedDracul]

Pull
Aim
Squeeze
Sweep?

I swear, my home hospital badge comes with 5 separate cards with equally useless information like that.

That's a terrible acronym for masturbation.

 

[DermViser]

Actually Path was one of my favorite med school classes (besides Psych!), but I've heard the job market for that field is abysmal, so it's a no-go I fear.

There is also Radiology too.

 

[DermViser]

Yeah, that's me. I mostly had to teach myself how this social **** works, and I don't enjoy any of it, I just pretend to. Maybe that's why I'm foreveralone haha.

I don't think it's atypical in medical school though. You have to be kinda craycray to pick this career, and as I found out, there are people even less sociable than me here.

I used to love Dungeons and Dragons too.

Also the problem is that a lot of medical school education squeezes the humanism out of people as well. IMHO, the ones that were the most, "humanistic" and "idealistic" students in entering medical school, became one of the most jaded and disillusioned students by the time MS-4 came around. All the while bombarded by the theme of "professionalism" by med school administrators, while unprofessional faculty/residents are allowed to roam about and terrorize others, with no consequences.

Compound this with certain medical school faculty on the wards, it's any wonder why people run towards certain specialties. It's actually why I like Dermatology, bc it's a specialty that allowed me to keep and maintain my humanism, if not grow it more. Certain specialties if I had gone into them, would have destroyed that.

 

[boogaloo]

Also the problem is that a lot of medical school education squeezes the humanism out of people as well. IMHO, the ones that were the most, "humanistic" and "idealistic" students in entering medical school, were one of the most jaded and disillusioned students by the time MS-4 came around. All the while bombarded by the theme of "professionalism" by med school administrators, while unprofessional faculty/residents are allowed to roam about and terrorize others, with no consequences.

Compound this with certain medical school faculty on the wards, it's any wonder why people run towards certain specialties. It's actually why I like Dermatology, bc it's a specialty that allowed me to keep and maintain my humanism, if not grow it more. Certain specialties if I had gone into them, would have destroyed that.

For what it's worth, the dermatologist I worked with had excellent bedside manner and was not jaded at all. He is also insanely intelligent and likes to show us pictures of his airplanes.

 

[DermViser]

For what it's worth, the dermatologist I worked with had excellent bedside manner and was not jaded at all. He is also insanely intelligent and likes to show us pictures of his airplanes.

I think the happiest doctors are the ones who have some sort of release, where they have time for areas of interest outside of just medicine. They were also better able to relate to their patients. Medicine and life isn't just being in the hospital, studying, and reading journals.

The unhappiest doctors tended to be the ones who were overworked, with interests only being medicine. Funny enough these were the same ones lecturing to others about medicine being a "calling". For them I guess, entering medicine was somehow akin to entering the priesthood.

 

[SouthernSurgeon]

haha just be like dr. house, no empathy but hilariously charming 🙂

Actually, I'd say Arkangeloid is like Dr. House but without the hilarious charm.

And actually come to think of it...without the diagnostic brilliance either...

 

[SouthernSurgeon]

Uh, definitely not my badge. I googled it, as someone here mentioned a "NURSE" mnemonic for empathy.

I hate that acronym so much based solely on the fact that it is named "NURSE" as though to not so subtly imply that nurses are by nature more empathic than doctors.

 

[DermViser]

I hate that acronym so much based solely on the fact that it is named "NURSE" as though to not so subtly imply that nurses are by nature more empathic than doctors.

Thought the exact same thing myself. It continues to perpetuate the stereotype of the nurse as somehow being Florence Nightingale, which they have capitalized on immensely when it comes to scope of practice laws. I like this article on that topic: http://www.kevinmd.com/blog/2012/11/doctors-nice-nurses-time-change-brand.html

 

[Arkangeloid]

Actually, I'd say Arkangeloid is like Dr. House but without the hilarious charm.

And actually come to think of it...without the diagnostic brilliance either...

Right, and I suppose you were an expert diagnostician in your first year of medical school too.

 

[DermViser]

Right, and I suppose you were an expert diagnostician in your first year of medical school too.

He's a surgeon, don't worry about him too much. It won't help.

 

[Arkangeloid]

He's a surgeon, don't worry about him too much. It won't help.

Oh, that explains everything lol. I thought he was in IM going by the name.

 

[DermViser]

Oh, that explains everything lol. I thought he was in IM going by the name.

Yes, it's quite the misnomer, I thought he was IM at first as well.

 

[Priapism4tooLong]

Yeah, that's me. I mostly had to teach myself how this social **** works, and I don't enjoy any of it, I just pretend to. Maybe that's why I'm foreveralone haha.

I don't think it's atypical in medical school though. You have to be kinda craycray to pick this career, and as I found out, there are people even less sociable than me here.

I used to love Dungeons and Dragons too.

Be less like jack Nicholson in the shining and more like patch Adams

 

[Priapism4tooLong]

Right, and I suppose you were an expert diagnostician in your first year of medical school too.

I'm the only expert here