Assessment And Clinimetrics Topic 1-9 PDF

TOPIC 3: CLINICAL INTERVIEW Communication process between the health professional and patient Chance to get to know the patient. Clinical Interview, Physical examination (DATA OBTAINING) Powerful tool —> brings an accurate diagnosis in 75% of cases. Professional communication skills are related to:...

TOPIC 3: CLINICAL INTERVIEW Communication process between the health professional and patient Chance to get to know the patient. Clinical Interview, Physical examination (DATA OBTAINING) Powerful tool —> brings an accurate diagnosis in 75% of cases. Professional communication skills are related to: -Patient satisfaction -Treatment compliance -Perception of professional competence -Perception of the own health status Patient trust is gained within the first minutes of a PT consultation PT- Patient Relationship Peculiarities - Proximity with the patient: Emotional and Physical - Type of therapy - Dealing with pain, disabilities - Frequence of Treatment -Time of consultation Types of clinical Interview According to the structure: Free/ Non-formal: Psychology and psychiatry Directed/ Structured: Research, school, office. Semi-Directed/ Semi-structured According to the orientation: Patient Oriented Activates patient’s own resources (exercises, change of habits) Work with patient’s ideas, expectations, and emotions as part of the health problem. PT Oriented Centered on the PT (paternalistic approach) Problem solver Key aspects oriented to the patient: Connection Empathizing (express emotional solidarity) Educating (evaluate the understanding and allow asking) Expectations (explore and take into account beliefs and opinions of the patient + demonstrate you have understood them) Enrolling (patient involvement = assume responsibilities) Influencing Factors Context Professional image: Physical appearance Basic hygiene Body language Aware of non-verbal signs Orientation, body position Gestures Genuine behaviour OUR POSITION AS RELAXED AS POSSIBLE AND OPEN, AND NEUTRAL AT THE SAME TIME. Physical space Avoid barriers Patient - PT distance Listening Ability to listen vs hear, and to look vs see. Speed slow and clear Open and short questions —> less limits, more genuine allows MORE info. Closed questions —> when i need specific info SEMISTRUCTURED INTERVIEW A. Exploratory Phase 1. Greeting Welcome Warm Formalisms 2. Define reasons of consultation Complaints of … Open questions (beware of influencing responses) On time questions 3. Get info on the nature of the problem and beliefs and expectations Spontaneous comments/ reactions Feelings (FEARS!) 4. Include family, social and job data Important in some complex situations. Narrative supporting techniques LOW REACTIVITY = Less interruptions FUNCTIONAL SILENCE = Emotional reaction catalyst FACILITATION, verbal & non-verbal = Mediate and focus EMPATHY (unbiased) PARAPHRASING (repeat using different words) DO NOT ABUSE ! CONFRONTATION Work Handling Skills Parallelisms i.e: “Do you associate your change of job with the onsite of your symptoms ?” Brevity Spontaneous information Key words (in and out of context) Common mistakes Impersonal greeting Not clarifying the reason of consultation Focus the interview on secondary complaints Bias the questions Lack of control of the interview A. RESOLUTION PHASE 1. Informative Stage Announce information: -Inform of the health problem -Propose a treatment plan State the problem(s) identified: -Use easy examples -Check for understanding -Two-way communication Common mistakes Use of voice Too many technical terms One-way conversation Interrupting the patient Not check for understanding Negotiation stage Negotiation skills: -Topics for discussion -Exchange of views, brainstorming -Final agreements 2. Dialogue stage -Outline the problems -Accept or make suggestions 3. Agreement stage Make a deal: compromises and/ or responsibilities of PATIENT AND PT= Double deal Wait: take the time needed to see how it evolves. Refer Broken record: situations that need limits, or assure information, avoid damage. Negotiation Goals Recognise the patient’s right to participate Develop an evolutive answer Develop negotiations skills Respect the patient’s final decisions Closure of the interview General summary, verification “Safety net” Warning of possible unfavourable developments Report of the most probable diagnosis = Control the situation Final clarifications: When to come back.