1. History Taking & Relationship Building September 19 th 2006 Dr. Lanice Jones

2. Relationship Building – 4 Rules What do you want? What do you think is going on? Explore Emotional Content Empower the Patient!

3. EMPATHY Each patient seeks empathic understanding. They Want to know they are seen they are heard they are understood

4. EDUCATE Doctors believe they do a good job at this Myth! They over estimate the amount of time spent They rarely check for understanding

5. EDUCATE Technique 1 Assume patient has these questions: 1. What has happened to me? 2. Why has it happened to me 3. What happens next 4. What are they doing to me/for me? 5. Why this instead of that? 6. Will it hurt? How much? How long? 7. When will you have some answers? 8. When will I know what it means

6. ENLIST TECHNIQUE: Discuss patients beliefs For example: “I’ve one possible explanation for the symptoms ……… How does that fit with your thinking?

7. The 4 Most Important Points for Relationship What Do You Want? What Do You Think is going on? Explore Emotional Content Empower the Patient

8. What do you want? – Your most efficient question What were you thinking or hoping would happen coming today? (in hospital?) What did you want to happen on this visit What were you hoping to get out of this visit

9. What do you think is going on? This is the Belief Question This is your most effective relationship builder Do you have any thoughts or ideas on what might be the cause of this? Do you have any idea as to what this might be? Are there any concerns that you want me to check out about what this might be?

10. Explore Emotional Content Notice the emotional clues or hints the patient offers Identify the emotion, or check into what you think it might be Ask what is going on or what the emotion might be about Don’t wait for the patient to bring it up – you have to take action by asking the patient about the emotion they’ve brought forward, even unconsciously Why don’t doctors do this more?

11. What to do Next: BATHE Background – the story about what is happening Affect and Effect (how does it make you feel, (Affect = feelings) Effect is how does it effect you with sleep, concentration, friends, appetite, weight loss Troubles you the Most or The Worst Thing How are you Handling it? (How are you coping Empathetic Statement

12. Empathetic Statements Observe something real about the patient Mention that real thing Hook this onto a positive attribute that affirms the patients overall wholeness and ability to cope For example: You’ve told me about the trouble you are having. I’ve observed how resourceful you were in getting here today. That gives me the idea that you have strength and courage….

13. Your best Empathy Builders Mirror the patient’s posture, then slowly open up your own posture Make use of the “Put Down The Pen” sign. Reflect back the Sense the patient unconsciously uses Avoid generalization statements – use empathetic statements instead.

14. Empower the Patient Avoid paternalistic comments – we’ll take care of you At most, join in working together with the patient Give the patient a task ie: come and see me in a week and see what strategies you come up with