Taking a good contextual history of a patient (1 Viewer)

[D30417995]

Hi all,

I have an interview exam coming up soon. The task is to take a contextual history of a patient (played by an actor/actress). For this first year exam, we don't need to focus too much on the medical side of things; mostly the psycho-social aspects of the patient's problems.

Do you guys have a good strategy to tackle this sort of interview, perhaps in the form of a checklist or mnemonics that would enable you to discover as much about the patient's concerns/problems as possible? I know that the actors/actresses have been instructed by the Faculty not to disclose much of the pertinent info unless we specifically ask for them. I have practised numerous times with friends but I almost always invariably get stuck without knowing what else to ask 4 minutes into the interview; the interview exam will last 9 minutes. I'd really appreciate any suggestions/tips/hints/resources that you fellow med students can provide.

Thanks a lot in advance!

 

[vodkacrumble]

can you get your hands on an admission package from a local hospital? for psycho-social issues you might even be best getting a Mental State Assessment form as it has all the sections.
you can use it as a template for what you'd like to ask.

 

[+Po1ntDeXt3r+]

HEADS
H-Home
E-Education
A-Activities
D-Drugs
S-Suicide/Sexuality

CAGE- if there is suspected alcohol problems

there are more..
basically the whole chapter of a clinical skills textbook on taking social/drug/sexual/family histories..

in fact there are whole books and articles on it..

stuff on difficult patients... not exactly.. wat ure up for.. but it sounds kinda close..
http://www.australiandoctor.com.au/HTT/pdf/020726/AD_HTTV_26JUL02.p1 lr.pdf
http://www.australiandoctor.com.au/HTT/pdf/020726/AD_HTTVI_26JUL02.p1 lr.pdf

 

[+:: $i[Q]u3 ::+]

1. Don't interrupt the patient's opening spiel. Average opening in clinical practice is 90 seconds, but it can go on longer. After they finish, pause and count to three (in case they have anything left to say) before asking questions.

2. Set an agenda, eg "I'd like to spend some time focusing on your symptoms, then I'd like for us to have a chat about how this is affecting your life as a whole, would that be alright?".

3. Most often the patient will provide a verbal or non-verbal clue about their major concerns. It's important to pick up on these. Ask and clarify "I sense that you're worried...", "Am I right in saying that this is your main concern?..."

4. Otherwise, ask away. I try to think patient-centred issues then work outwards. A couple of things you should ask:

- How is the patient coping?
- Has the condition been affecting the patient's day-to-day activities? How?
- Has it been affecting their work?
- Who they live with, do they receive extra support or help at home?
- Has the condition been affecting their relationships with family and/or friends?

Try not to think of them as "checklist" because otherwise it's tempting to move on to the next question after asking one. Ask the patient to clarify each point and paraphrase it back to them so that you have a clear understanding of the patient's concerns.

5. Four words: How. Do. You. Feel.
Throw it in whenever you can (without overdoing it, of course). "I can understand this would have quite an impact on you life. How do you feel at the moment?".
Yeah. If you're stuck, just ask them how they feel.


BTW, 9 minutes is extremely short. A good psychosocial history really takes closer to twenty or thirty minutes. You're really trying to gain an understanding of who this person is, what are they thinking, how do they feel.
Good luck, have fun.

----------------------

(afterthought)
*Haha... Oh dear lord. I'm the official spawn of the UNSW New Med Course.
I feel dirty..............

 

[vodkacrumble]

i agree that 9min is very short.

when i did an OSCA in 1st year (nursing) I had 15min to do a set of obs, pain scale and find out what issues were going on in the patient's life to make them feel stressed.
it was over before i even started getting into it.