Patient interactions & history taking By Dr. Mohsen Dashti Patient care & management 202 March-28-2010

Discussion issues Personal understanding. Methods of effective communication. Various types of patients. Patient interview. Elements of the clinical history.

Personal understanding How important is effective interacting? Build the trust between the technologist and patient. Increase technologist’s self-esteem. Eliminate miscommunication problems. Decrease repeat rates. How?

Personal understanding What do patients need? Dignity: Patients could loose & need various steps described in Maslow’s hierarchy of needs. How? -- If a patient is very sick, they could loose sleep (level one). -- If a patient feels not safe or unsecured (level two). -- if a patient has tube or other devices attached to them, they may not want to be around others (level three). -- If a patient has serious bowel or vomiting problems (level four).

Personal understanding Patients Maslow’s hierarchy of needs: Level 1 (Physiologic) Level 2 (Safety & Security) Level 4 (Self-esteem & Respect) Level 3 (Love & Belonging)

Personal understanding Types of patients: Inpatient. Who? Someone who has been admitted to the hospital for diagnostic studies or treatment. Outpatient. Who? Someone who had come to the hospital for diagnosis or treatment but does not occupy a bed. -- level of personal understanding might differ from inpatients to outpatients depending on patient’s confidence, sickness level, mobility, type of exam, self-esteem… etc.

Methods of effective communication What is the number principle in patient care? Communication Develops self-esteem. Builds the trust between radiographer and the patient. Makes it easier to control the patient and any other situation that might develop as a result. Eases the examination process. Allows the patient to be more comfortable.

Methods of effective communication Types of Communication: Verbal Communication: Use simple vocabulary. Clarity of voice. Organization of sentences based on patient level. Humor and good spirit. -- Avoid age, sex, race, religious discrimination and jokes.

Methods of effective communication Types of Communication: Nonverbal Communication: Paralanguage -- Attitude and communication skills. Body Language -- Don’t ask about the comfort level when you don’t even offer a pillow or a blanket. -- Smile and make direct eye contact when talking to the patient.

Methods of effective communication Nonverbal Communication: Touch -- For emotional support, emphasis, and palpation. Professional Appearance -- Dress accordingly and always look nice. Physical Presence -- Body Posture. -- High self-esteem and be confident.

Various types of patients Seriously ill & traumatized patients: In this category, patients often do not or can not talk or cooperate, but still clear instructions must be given. Determining the coherence level is vitally important. Why? -- To determine the consciousness level of the patient. Quick and effective work must be taken to avoid increasing patient discomfort. Visual indications of changes in vital signs must be monitored. Why? -- To stop any possibility of severe consequences or even death.

Various types of patients Visually impaired patients: Attempt to gain patient’s trust is a must to ease up examination process. Clear instructions and using simple terminology assures patients. Gentle touch establishes that someone is near if needed. Speech & hearing impaired patients: Writing instructions can be useful with patients who can read. Examination simulation can help hearing impaired patients. Do not insult patient’s intelligence.

Various types of patients Non-Arabic (English) speaking patients: The use of touch, facial expression and simple instructions is very helpful with those patients. Clear pronunciation of simple words can help patients to understand. Mentally impaired patients: Thorough knowledge of equipments & immobilization techniques as well as interaction skills is a must with these types of patients. Strong and reassuring tone of voice must be used. Continuous conversation must be maintained to calm patient down.

Various types of patients Substance abusers: They are patients under the influence of alcohol or drugs or any other type of addiction. -- Most patients not aware of their behavior and extra attention must be given. -- Constant monitoring of patient behavior must be practiced. -- Affirmative action must be taken when patient is misbehaving to avoid serious problems. -- Extra help or staff is recommended to have in the examination room to secure the situation.

Patient interview Why is it important to interview patients? To understand the necessary clinical history in order to perform the correct examination procedure. -- Most examination requests describe brief and unclear reason for a specific procedure. -- General indication is mentioned (i.e x-ray hand) without mentioning where exactly is the pain. -- Avoiding serious mistakes of examination sites can be done with appropriate clinical patient interview. -- Gaining patient trust and giving some mental healing help can be established during patient interview.

Patient interview Questioning skills: Open-ended questions: let the patient tell the story. Facilitation encourages elaboration. Silence or giving the patient time to speak out. Probing questions provide more details. Repetition clarifies information. Summarization verifies accuracy.

Elements of the clinical history The sacred seven: Localization: Defining as exact & precise area as possible for the patient’s complaint. Chronology: The time element of history taking where duration since onset, frequency and course of the symptoms should be established. Quality: The character of the symptom is described such as the color of body fluids, the presence of clots, the size of lumps or lesions, the type of cough… etc.

Elements of the clinical history Severity: This describes the intensity, the quantity or the extensiveness of the condition or problem such as the intensity of pain, the number of lumps or lesions, and the extend of burn. Onset: Describing the onset of the complaint involves the patient’s explaining what was he/she doing when the illness or condition began. Aggravating or alleviating factors: The circumstances or conditions that produce or provoke the problem should be well defined.

Elements of the clinical history Associated manifestations: Might be necessary to determine whether there are other symptoms that accompany the chief or main complaint.

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