V2 Berek & Novaks 9781496380333

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Chapter 1 • Initial Assessment and Communication

Table 1-3 Behaviors Associated With the 14 Structural Elements of the Interview a

Negotiating a Priority Problem Ask the patient for priorities State own priorities Establish mutual interests Reach agreement on order of addressing issues Developing a Narrative Thread Develop personal ways of asking the patient to tell her story Ask when last felt healthy Ask about entire course of illness Ask about recent episode or typical episode Establishing the Life Context of the Patient Use first opportunity to inquire about personal and social details Flesh out developmental history Learn about the patient’s support system Learn about home, work, neighborhood, safety Establishing a Safety Net Memorize complete review of systems Review issues as appropriate to specific problem Presenting Findings and Options Be succinct Ascertain the patient’s level of understanding, cognitive style Ask the patient to review and state understanding Summarize and check Tape record and give the tape to the patient Ask the patient’s perspectives Negotiating Plans Activate the patient Agree on what is feasible Respect the patient’s choices whenever possible Closing Ask the patient to review plans and arrangements Clarify what to do in the interim Schedule next encounter Say goodbye

Preparing the Environment Create privacy Eliminate noise and distractions Provide comfortable seating at equal eye level Provide access Preparing Oneself Eliminate distractions and interruptions Focus Self-hypnosis Meditation Constructive imaging Let intrusive thoughts pass through Observation Create a personal list of categories of observation Practice in a variety of settings Notice physical signs Presentation Affect What is said and not said Greeting Create a personal stereotypical beginning Introduce oneself Check the patient’s name and how it is said Create a positive social setting Introduction

Explain one’s role and purpose Check the patient’s expectation Negotiate about differences in perspective Be sure expectations are congruent with the patient’s Detecting and Overcoming Barriers to Communication Develop personal list of barriers to look for Include appropriate language Physical impediments such as deafness, delirium Include cultural barriers Recognize the patient’s psychological barriers, such as shame, fear, and paranoia Surveying Problems Develop personal methods of initiation of problem listing Ask “What else?” until problems are elicited

a Lipkin M Jr. Physician–patient interaction in reproductive counseling. Obstet Gynecol 1996;88:31S–40S. Derived from Lipkin M, Frankel RM, Beckman HB, et al. Performing the interview. In: Lipkin M, Putnam SM, Lazare A, eds. The Medical Interview: Clinical Care, Education, and Research . New York: Springer-Verlag; 1995:65–82.

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