week 1: chapters 11&12 History Taking: Interview Skills

History Taking

• The radiologic and imaging sciences professional should be able to describe their role in taking a clinical history.
• Taking a patient history should be regarded as an interview.
• Information gathered needs to be accurate and specific.
• A history needs to include relevant information for the examination.
• To show genuine interest, attentiveness, and professional competence can provide patients with a real sense of caring.
• Information needed by the radiologist is specific to the patient's reason for the examination.
• Collected data needs to be documented precisely and clearly, using appropriate medical language.
• Radiologists want to know the patient's chief complaint.
• The most important question to ask when taking a history is why the examination is being done.

Qualities of an Interviewer

• The desirable qualities of a good patient interviewer should be displayed.
• Acknowledge a patient's anger, if they are angry.
• Always respect the patient.
• Be genuine and empathize (not sympathize) with the patient’s condition.
• Don’t intimidate patients and be attentiveness to detail.
• Demonstrate accurate note-taking skills and have good questioning skills.
• Develop multitasking and communication skills.
• Maintain a polite and professional demeanor.
• Ensure the patient feels the information they are providing is important.

Objective Data

• Objective data should be differentiated from subjective data.
• Objective data is perceptible to senses.
• Objective data is able to be measured.
• Objective data is often physiologic.
• Examples of Objective date are signs that can be seen, heard, and/or felt.
• Objective and subjective data are equally important.

Subjective Data

• Subjective data should be differentiated from objective data.
• Subjective data include patient feelings, pain level and attitude.
• Subjective data include opinion of observer.
• Subjective data is subject to interpretation.
• Objective and subjective data are equally important.

Questioning Skills

• Use open-ended and probing questions to focus in on more detail.
• Avoid leading questions.
• Facilitate a response from the patient, and remain quiet to get a response.
• Repeat patient responses to clarify and confirm information collected.
• Summarize to verify accuracy.

Steps in Clinical History

• It is important to clarify the chief complaint.
• Chief complaint is the main focus.
• Permit the patient to add more than a single complaint when multiple complaints are valid.
• Do not ignore all symptoms except the most predominant, you may miss other important clinical information.

Sacred Seven of Medical Histories

• The important elements of each of the "Sacred Seven" elements of the clinical history should be detailed.
• Localization, localized versus non-localized
• Chronology
• Quality
• Severity
• Onset
• Aggravating or alleviating factors
• Associated manifestations

Patient History Considerations

• The value of each of the six categories of questions useful in obtaining clinical histories should be understood.
• Does patient history data match the requisition?
• Do symptoms support the exam?
• Verify symptoms with exam request.
• When describing pain, consider the location, where it is felt, how long the patient has had it, the duration, and if it is old or new.

Role of a Technologist

• Act as a good listener and take accurate notes, recording them appropriately.
• Get answers to key clinical questions.
• Present a professional image and play an important role in interacting with the patient.
• Become a patient advocate.

Technologist Clarification of Medical History

• In certain instances when there is an inconsistency between a patient's medical history and the type of medical procedure ordered, clarify with the ordering practitioner and a radiologist.

Conclusion

• Consider the patient history as an interview.
• A complete medical history includes both objective and subjective data.
• Demonstrate respect, compassion, and empathy for the patient's condition.
• Determine clearly the patient’s chief complaint.
• Gather all data pertinent information relative to the procedure.
• Look for objective and subjective data, and take accurate notes with attention to detail presenting a professional image.
• Observations and assessment helps radiologists.
• Those in the radiologic and imaging sciences profession are often the eyes, ears, and voice of the radiologist with the patient.

Patient Interactions

• Identify qualities needed to be a caring radiologic and imaging sciences professional.
• Specify needs that cause people to enter radiologic and imaging sciences as a profession.
• Relate differences between the needs of inpatients and those of outpatients.
• Explain why patient interaction is important to patients, families and friends.
• Analyze effective methods of communicating with patients of various ages.
• Discuss considerations of the physical changes of aging with regard to radiologic and imaging science procedures.
• Discuss appropriate methods of responding to terminally ill patients.

Patient Needs

• Realize that patients would naturally choose to visit a nice restaurant than the medical imaging department.
• Patients are in an altered state of awareness when visiting medical imaging.
• Patients often experiences fear of the unknown, loss of control, unnatural emotions, possible pain and discomfort, and apprehension about exam results.
• Securing a patient’s cooperation is one of the most important and challenging parts of your role as a radiologic and imaging sciences professional.

Emotional Intelligence of Technologists

• Self-awareness
• Self-regulation
• Motivation
• Empathy
• Social Skills

Personal Needs for a Technologist

• Helping others
• Working with people
• Making a difference
• Thinking critically
• Demonstrating creativity
• Achieving results
• Working with patients requires an understanding of one's emotional intelligence.
• Personal needs, when met, yield increased confidence in technical abilities which the patient perceives as competence.

Communication Skills

• Understand what you’re walking into when greeting a patient.
• Understand and "have in check" current emotions working with patients.
• Emotions should demonstrate caring and empathy for patients.
• Individuals with high emotional intelligence are said to be more successful on and off job.

Maslow’s Hierarchy of Human Needs

• People strive from a basic level of physiologic needs toward a level of self-actualization.
• Each level of needs must be satisfied before an individual proceeds to the next level.
• Patients are often at the lower levels of Maslow’s hierarchy.

Patient Dignity

• Patient dignity deals with a patient’s self-esteem, feeling a loss of power over their fate
• Embarrassing situation, loss of privacy isolates them from others creating feelings of guilt
• Do not reference patients in an impersonal or slang fashion.

Initial Patient Interaction

• Assess the patient using their name, ask preference for a name and confirm their identity.
• Introduce yourself and explain the procedure in terms the patient can understand.
• Obtain a brief and relevant history, informed consent, if required.

Communication with Patient

• A patient’s family and friends should be viewed as an “extension” of the patient in terms of communication methods.

Patient Classifications

• Inpatients are admitted to the hospital for diagnostic studies or treatment.
• Inpatients generally occupy a hospital bed for 24 hours or longer.
• Inpatients move up and down Maslow’s hierarchy during their stay.
• Inpatients attitudes coming into medical imaging may have been shaped by previous hospital stay experiences.
• Outpatients come to the hospital or outpatient center for diagnostic testing or treatment but do not usually occupy a bed overnight.
• Outpatients often arrive to radiology with pre-conceived expectations.
• Outpatients usually have outside schedules or commitments to keep.
• Outpatients expect to be cared for on time, according to a scheduled appointment time.

Communication

• Communication and patient safety go “hand-in-hand”.
• Effective communication is ESSENTIAL at all levels of the healthcare delivery system via written, oral, and electronic form.
• Patient care communication must be patient focused and be accurate and timely.
• As a technologist, always remember to consider communication and relate with patient’s families and visitors.
• Follow practice standards of the profession and communicate within scope of practice.

Verbal Communication

• Spoken word.
• Written word.
• Voice intonation.
• Slang and jargon.
• Organization of sentences.
• Humor.

Nonverbal Communication

• Paralanguage
• Body language
• Touch
• Professional appearance
• Physical presence
• Visual contact
• Personal hygiene
• Body art

Touch

• Three common forms of touch used by the radiologic technologist including:
  • Emotional support
  • Emphasis
  • Palpation
• Before touching a patient, permission should be obtained. Touching without consent can have legal ramifications.

Common Patient Types

• Seriously ill and traumatized patients (Cancer patients and COVID patients).
• Visually impaired patients.
• Speech- and hearing-impaired patients.
• Non-English-speaking patients.
• Mentally impaired patients.
• Substance abusers.

Mobile and Surgical Communications

• Unique patient care environments require special patient communication considerations.
• Identify yourself, call the patient by name, outline qualifications, and explain the procedure.
• Consider visiting with family and friends if present.

Communication with Patient Family and Friends

• Professionally introduce yourself and briefly explain the procedure to family and friends.
• Explain why family and friends must remain outside the area during exposure.
• Empathy is a very powerful tool when dealing with a patient’s families and friends.

Age

• Effective communication strategies, patient age and any challenges factored into techniques.

Age Groups

• Infant
• Toddlers
• Preschoolers
• School-aged children
• Adolescents
• Young adults
• Middle-aged adults
• Mature adults

Pediatric Patients

• Come down to the child's eye level to speak, talk softly and less authoritatively.
• Set up equipment before the child enters the exam room.
• Use gentle touch and maintain eye contact.
• Soften room lighting and avoid loud and dramatic equipment movements.
• Use radiation protection methods and show them being used to family members, if present.

Gerontology

• This age group is expected to rise in numbers for years to come.
• Inappropriate terms include 'geriatrics', "Golden Agers" and "senior citizens".
• Treat older patients just like any other patient, regardless of age, with patience and respect while avoiding“childish language”.
• Aging is divided into primary and secondary aging.

Physical Changes of Functional Aging

• Slowing psychomotor responses and information processing.
• Decreased visual acuity and sense.
• Changes most often seen in patients in their 80s and 90s.

Common Conditions

• Respiratory System - Decreased cough reflex, shallow breathing, decreased pulmonary capacity, and kyphosis.
• Musculoskeletal System - Osteoporosis, arthritis, decreased muscle strength, atrophied muscle mass, and fear of fractures.
• Cardiovascular System - Decreased cardiac efficiency, orthostatic hypotension, arteriosclerosis, DVT, and general feeling of tiredness.
• Integumentary System - Loss of skin elasticity, change of skin texture, loss of touch sensation, diminished sensation of heat or cold, and loss of subcutaneous fatty layer.
• Gastrointestinal System - Loss of appetite, decreased secretions, decreased GI motility, and decreased sphincter muscle control.

Dealing with Older Patients

• Maintain eye contact and speak clearly and more slowly, addressing them not away from them.
• Keep them warm if needed and ask permission to touch.
• Demonstrate compassion and explain thoroughly and keep them informed asking them what makes them comfortable.
• Treat them with respect and patience.

Terminal Patients

• Understand that death is part of the life cycle.
• Radiologic and imaging sciences professionals often deal with the dying process as part of acute death events and are part of radiation oncology staff.
• Attitudes toward death and dying have changed to become more open and respectful of the terminal patient’s wishes and rights.
• Dying patients and their families and loved ones need to work through the grieving process in a natural and individualized timeframe following advanced directives and in accordance with patient autonomy.

Five Stages of Grieving Process

• Denial and isolation
• Anger
• Bargaining
• Depression
• Preparatory depression
• Acceptance

Conclusion -Communication

• Communication skills are essential to good medical imaging and increase the likelihood of exam success.
• A good communication process is a closed loop.
• Communication strategies need to accommodate the uniqueness of each patient.
• Patients are often vulnerable and outside their comfort zone entering the health care setting.
• Medical professionals act with compassion and empathy for the patient’s welfare.
• Aging and terminal patients create their own set of patient care challenges.
• Caring and empathy are critically important to achieving effective and compassionate patient care.