Taking a contextual history of a patient

[D30417995]

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Hi all,

I have an interview exam coming up soon. The task is to take a contextual history of a patient (played by an actor/actress). For this first year exam, we don't need to focus too much on the medical side of things; mostly the psycho-social aspects of the patient's problems.

Do you guys have a good strategy to tackle this sort of interview, perhaps in the form of a checklist or mnemonics that would enable you to discover as much about the patient's concerns/problems as possible? I know that the actors/actresses have been instructed by the Faculty not to disclose much of the pertinent info unless we specifically ask for them. 🙁 I have practised numerous times with friends but I almost always invariably get stuck without knowing what else to ask 4 minutes into the interview; the interview exam will last 9 minutes. I'd really appreciate any suggestions/tips/hints/resources that you fellow med students can provide.

Thanks a lot in advance!

 

[ljl1982]

I've had my fair share of standardized patient exams, and I agree that they can be kind of confusing (sometimes you are graded on empathy, sometimes you are graded on using the history to narrow the differential,etc.)

A few suggestions that might help:
-Treat the actor/actress like a real patient.
-Start with open-ended questions, let the patient do most of the talking
-Write notes to show the patient that you are listening (I'm just going to jot down a few notes to organize my thoughts,etc)

-At the same time, realize that when they are grading you for empathy/psychosocial stuff, they are trained to listen for "key words"...
---Examples: "The pain that you describe concerns me," "What seems to be most concerning for you?",
-Ask if the patient has any other questions or concerns that haven't been addressed.

 

[D30417995]

Hi ljl1982,

Thanks a lot for your tips! Those are some simple yet powerful lines!

Anyone else has any tips at all?

English is my second language; that makes it so much harder! 😎

 

[emack]

There are some things you can ask about when all else fails in SP interviews that at the very least will get you empathy points. These are good for contextual details when you've already exhausted the topic of their chief complaint & what it feels like & how bad it is & what makes it feel better/worse, etc etc etc.

-major stresses at work or home? Narrow this down if you've already had hints of a problem... ex. "How is your relationship with your boyfriend going?"
-particular worries or fears about current illness? ex. Do they secretly think it's a brain tumor but are afraid to tell you?
-most important way current illness is affecting their daily life? What about the effect on family members?
-what are they hoping the doctor can do for them? And if the first answer is "cure me completely" you can ask for more realistic goals if appropriate ex. symptom control.
-feelings about illness/health in general?
-Do you have any questions for me?
-Is there anything in particular that you want me to make sure your doctor knows? (This one works if the setup for your fake interview is that you're a med student reporting back to their real physician.)

SPs especially are just looking for opportunities to give you all the info in their script. At our school they always have lots of backstory provided. Open-ended questions are good with them because they pretty much know what you're looking for. They also know about your time limit.

 

[D30417995]

hi emack!

Thanks; that's some excellent advice! and yes, I'll be playing the role of a first year med student asking questions of the pt. and reporting back to the doctor.

 

[8744]

Jesus. Just ask the following:

"Habla usted english? Not even a poquito? goddamit."

"Is the babydaddy involved in the child's care?"

"Have you smoked crack in the last two days and if not, why not?"

"Did you really think the cops were going to let you get away with that?"

"If I give you a couple of percocet will you leave AMA?"

"Were you going to wait until your penis fell off to come in?"

"If your toe has been bothering you for three years, why are you here now...at five AM....just when my shift is ending?"

"Is your five-year-old staring at me because I'm the first male authority figure he's seen who wasn't beating you?"

Glad I could help.

 

[8744]

Here's some more that will help you put the patient in context:

"Does the bait shop down the road from your trailer park sell soap?"

"Toothpaste?"

"Let me guess: you fell on it...in the shower...right?"

"Is that 'Quintravion' with a 'Q' or a 'K'?"

"Can you please stop talking on your cell-phone while I examine you?"

"Do I have to turn off the Price is Right or will you pay attention to my questions?"

"I bet you didn't know crack could give you a heart attack, huh?"

 

[8744]

1. Major stresses at work or home? Narrow this down if you've already had hints of a problem... ex. "How is your relationship with your boyfriend going?"

2. Particular worries or fears about current illness? ex. Do they secretly think it's a brain tumor but are afraid to tell you?

3. Most important way current illness is affecting their daily life? What about the effect on family members?

4. What are they hoping the doctor can do for them? -feelings about illness/health in general?

5. Do you have any questions for me?

6. Is there anything in particular that you want me to make sure your doctor knows?

Also known as the six reasons I went into Emergency Medicine.

 

[D30417995]

doh!

 

[fun8stuff]

WICCA OPQRSTAAA PPCOATTS LOSST SSEEDS

Wash Hands
Introduce yourself
Comfort/confidentiality
Chief Complaint
Affect: how does this affect your everyday life?

Onset
Pallitive/provocative
Quality (dull, aching, sharp, tight, etc)
Region/Radiation
Severity (scale 1 to trri10)
Temporal
Attribute to what cause?
Any other symptoms?
Anything else you want to talk about today?

*review what patient just told you and ask you have it all correct.

Past Medical history (birth, childhood illnesses, any medical conditions)
Past hospitilizations/surgeries/ER visits/broken bones/ fractures
Current meds
OTC/CAM
Allergies
Tetanus/Immunizations
Tree (family tree)
Screen (paps, mammography, prostate, colonscopy- depending on age and sex)

Living Situation
Occupational Hazards (or dangerous hobbies)
Sleep Problems
Stress or Loss in life?
Travel our of country recently?

Safe - do you feel safe in your environment
Smoking/EtOH/Street Drugs
Education (highest level acheived)
Exercise
Diet
Sex

Quick review of systems if have time... HEENT chest heart digestive system, muskuloskeletal, etc