psych/thyroid eval

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So i'm a new resident and i just want to know if any of you guys have any tips on how to ask these questions

1. any suicidal/homicidal ideation?

2. any audio/visual hallucination?

it seems that with (1) and (2) if i ask it directly in that way, i get a very robotic "no of course not!"--what i want to know is if there is a better way to ask those 2 important questions that can let me tap into that population who at risk for psych dz?

and for thyroid disease how to ask

3. cold/heat intolerance?

i tend to have the same problem

would anyone be able to give me any pointers to smooth out my h&p skills?

 

[deleted87716]

i just want to know if any of you guys have any tips on how to ask these questions

any suicidal/homicidal ideation?

Do you ever think that you might be better off dead?
Follow-on: Do you ever think about killing yourself?
Follow-on: Do you know how you'd do it?

Do you ever wish someone else were dead?
Follow-on: Do you ever think about killing them?
Follow-on: Do you know how you'd do it?

any audio/visual hallucination?

Do you ever hear things that other people don't hear?

Do you ever hear voices?
Follow-on: Do they tell you to do things?

Do you ever see things that other people don't see?

and for thyroid disease how to ask

cold/heat intolerance?

Do you never feel unusually hot or cold when other people aren't?

 

[hippiedoc13]

1. any suicidal/homicidal ideation?

"Sometimes when people are feeling this bad, they start to feel like they would be better off dead. Have you ever felt this way?"

And I like all of Blue Dog's suggestions, they all tend to work well.

As a side note, a big part of successfully eliciting these symptoms is not just the wording, but the tone and attitude with which they're asked. I have found that taking an empathic but matter-of-fact tone tends to best elicit these type of symptoms that some patients may be afraid to reveal (esp. those who may be experiencing them for the first time in their lives). Basically with my tone and body language, I want to simultaneously convey two nonverbal messages: "I care about your individual experience and want to help" and "Don't worry, I have seen it all and there is nothing you could possibly say that's going to shock or frighten or disgust me or make me judge you"

In my experience, the two areas that many providers are uncomfortable with are sex and psych (esp psychosis and suicidal ideation). Unfortunately many tend to unintentionally convey that discomfort through tone of voice or body language. Patients can tell when we are uncomfortable, and it makes them uncomfortable, and less likely to share openly. So cultivating a neutral expression, matter-of-fact tone, and relaxed body language are helpful

 

[cali-ob]

"Sometimes when people are feeling this bad, they start to feel like they would be better off dead. Have you ever felt this way?"

And I like all of Blue Dog's suggestions, they all tend to work well.

As a side note, a big part of successfully eliciting these symptoms is not just the wording, but the tone and attitude with which they're asked. I have found that taking an empathic but matter-of-fact tone tends to best elicit these type of symptoms that some patients may be afraid to reveal (esp. those who may be experiencing them for the first time in their lives). Basically with my tone and body language, I want to simultaneously convey two nonverbal messages: "I care about your individual experience and want to help" and "Don't worry, I have seen it all and there is nothing you could possibly say that's going to shock or frighten or disgust me or make me judge you"

In my experience, the two areas that many providers are uncomfortable with are sex and psych (esp psychosis and suicidal ideation). Unfortunately many tend to unintentionally convey that discomfort through tone of voice or body language. Patients can tell when we are uncomfortable, and it makes them uncomfortable, and less likely to share openly. So cultivating a neutral expression, matter-of-fact tone, and relaxed body language are helpful

totally agree. It's all about how you present it.

 

[deleted6669]

So i'm a new resident and i just want to know if any of you guys have any tips on how to ask these questions

for thyroid disease how to ask

3. cold/heat intolerance?QUOTE]

one of my attendings inquires about thyroid issues by asking(among other questions) what temp they keep their thermostat at home set at. if the # is way off base ( 95 degrees yr round for example) he does a thyroid workup.