Taking a good contextual history of a patient

[D30417995]

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Hi all,

First of all, I'm sorry that this post may not be directly related to psychiatry residency. I post it here only because I believe that people who specialise in psychiatry (or FM) are very likely the most proficient in taking a good and complete contextual history of a patient.

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!

 

[OldPsychDoc]

Hi all,

First of all, I'm sorry that this post may not be directly related to psychiatry residency. I post it here only because I believe that people who specialise in psychiatry (or FM) are very likely the most proficient in taking a good and complete contextual history of a patient.

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!

What I tell my med students is that you've got to be CURIOUS about the patient. I just then use a lot of open ended questions (Who do you live with right now? How is that going? Who do you have in your life that cares about what's going on? How far did you get in school? Where do you see your self going in the next 3 years? etc. etc.) and follow up on their answers. That allows a pretty comprehensive picture of the psychosocial context to emerge.

Also, by 9 minutes in, you should be asking yourself "Why now?" and findinf someway to ask this if you haven't already figured it out. You'll be amazed how often stuff goes on for years, but they finally come in because 1) the police are now involved, 2) their spouse left them, 3) they lost their job (or just got a job, so now have insurance!), or ________ you name it...

 

[Triathlon]

I took this same exam two years ago and i remember the anxiety involved. I had had a few years of experience prior to medical school interviewing people for social histories so it came naturally, but the time frame was stressful and trying to make sure I got the information "they" wanted. My advice is this:
Find out what information is required specifically (ie. sexual history; years active, how many partners, male, female, both, protection, pregnancies, drug or alcohol invovlment, abuse hx, ED, anorgasmia, etc. etc.)
Once you know what information you need, it makes it easier to get it. You have a checklist of sorts.
Use a couple of those minutes to build rapport. This makes a social history much easier.
Ask about details of the history, make the pt. feel like you care not just filling in check marks yes or no.
Be empatheic to their answers also.
These are tools that will help you in real life and kill some time for your test. Also, the actors grade you on how you make them feel.