1. “Mr/Ms…..?” in a questionable tone.
2. “Hi, I am Dr …….…(last name)”.
3. Nothing or “I am covering for Dr….today” or “I am the physician on duty here today”.
4. “Mr/Ms….., how would you like me to address you?”
5. Nothing or “Be seated please.”
TIPS:
- Practice this step.
- Memorize the ten steps in sequence.
- Imagine the patient is setting on your right (and the examiner on the left) and practice. Now change positions and practice. Imagine the patient is lying down on a stretcher on your right, then left, then in front.
- Practice the ten steps over and over and over until you feel you are doing them naturally and confidently.
- Don’t worry about how long it takes to do it at the beginning. Just master the steps first. Then, with time try to be faster and faster to finish it with 15 SECONDS or less.
- After you master it. Do it in front of family members or study group. Ask them to criticize you honestly and freely. Ask them about your nonverbal communication, voice tone, gestures, eyes and eyebrows movements, lips movements, standing position, head position and look
- Accept critics openly and adopt changes. Check OSCEs Home
communication skill page at http://www.oscehome.com/Communication-Skills.html.
- Practice and practice and practice. Never underestimate the importance of acting and living the steps. Don’t tell yourself that you will do so and so, DO IT. Just do it.
- You can do it !
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Chapter 9: THE CHIEF COMPLAINT
10 steps to be done in ONE minute:
1- “Mr./Ms… I’ll be writing down some notes while we talk,.. okay?”
2- Clarifying the Chief Complaint (CC): “I understand, you have been having some….(CC from the stem question)”(best sentence) or “How can I help you?” or
“What brings you here today?”.
3- Write down the CC in patient’s words.
4- Make sure what is the real CC: “So, you have …(CC), …. Let’s talk about it, but first, is there anything else bothering you? Are you having any other problems physically? Or, are there any special stresses in your life right now?.”
If yes “Which one do you want us to discuss first/today?”
5- Invite him/her to tell their story “Tell me all about the …(CC)right from the beginning”.
6- Maintain eye contact, don’t interrupt, facilitate and encourage with sounds (Ah ha, yes, go on, I see), head nodding, and empathy facial gestures.
7- When he/she stops, explore the CC if he/she uses vague terms like tired, dizzy, diarrhea .etc, “What do you mean by…....?” Offer menu list of 2-3
descriptions.
8- Duration: “When would you say it started?” make sure “So it started .…
ago?”.
9- If CC presents for some time: “What made you decide to get it checked now?”
10- Empathy: Watch your voice tone and facial expressions
“That must be very difficult for you to cope with?”
“I can see you have been under a lot of stress”
“How are you feeling about that?”
“How has this been affecting you?”
“I can see you are/ It sounds like you’re feeling / You seem (anxious/ worried/ angry/ upset/
frightened) …….. Is that right?”
“This is completely understandable. Most people in similar circumstances would react just as you are.”
“I am sorry to hear that.”
“It must be hard for you, what are you unable to do as a result of the …(CC)”
“It would be surprising if you didn’t feel (angry / upset / worried / frightened) after hearing that / waiting all that time.”
“This can’t be an easy time for you, we’ll work together to get through this.”
Reasons to come now are:
1. Symptoms worsen.
2. Anxiety developed, even if symptoms lessen.
3. An excuse for a hidden CC.
Patient’s non-verbal cues of distress:
- Avoiding eye contact.
- Fidgeting.
- Shifting around in the chair.
- Holding their body tensely.
However, don’t assume that, check it out with them. (? Cultural).
Silent or Talkative patient?
How to save time and direct the patient?
Find out how at thebook:
The History Taking Interview: The Chief Complaint
Sentences to be memorized in sequence:
1. “Mr./Ms… I’ll be writing down some notes while we talk,.. okay?”
2. “I understand, you have been having some….(CC from the stem question)” or
“How can I help you?” or “What brings you here today?”.
3. “So, you have …(CC), …. Let’s talk about it, but first, is there anything else bothering you? Are you having any other problems physically? Or are there any special stresses in your life right now?.”.
“Which one do you want us to discuss first/today?”
4. “Tell me all about the …(CC)right from the beginning”.
5. “When would you say it started?” “So it started .… ago?”
“What made you decide to get it checked now?”
6. Empathy sentences: Very important.
TIPS:
- Memorize the ten steps in sequence.
- Practice the ten steps over and over and over until you feel you are doing them naturally and confidently.
- Don’t worry about how long it takes to do it at the beginning. Just master the steps first. Then, with time try to be faster and faster to finish it with ONE MINUTE or less.
- After you master it. Do it in front of family members or study group. Ask them to criticize you honestly and freely. Ask them about your nonverbal communication, voice tone, gestures, eyes and eyebrows movements, lips movements, standing position, head position and look
- Accept critics openly and adopt changes. Check OSCEs Home
communication skill page at http://www.oscehome.com/Communication-Skills.html.
If the patient asked:
“Is it serious?”
“Am I going to die?”
“Do I have..(cancer, heart attack)?”
“Do you think that …(my medications/ work/ doctor/ partner….etc)is causing the ..(CC)”
Reply: “Mr/Ms…, I can see you are anxious and I am glad you came here today. We need to look on certain things and run some investigation to be sure.
Relax for now, together, we’re going to figure it out”
No false information or hope but also no worrisome comments.
Keep it neutral and open to both good and bad outcomes!
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