Culture
- set of learned and shared beliefs, values, traditions, languages, and norms applied to social interactions and interpretation of experiences
- cultures are dynamic
- cultures are created across many dimensions of identity
dimensions of identity that play into culture formation
- race
- ethnicity
- class
- age
- gender
- sexual orientation
- other social categories
Culturally Effective Care relates to
- health disparities
* communication skills
cultural competence
a set of congruent behaviors, attitudes, and policies that come together in a system, agency or among professionals that enables effective work in cross-cultural situations
structural competence
- recognize structures that shape clinical interactions
- observe and imagine structural interventions
- develop structural humility
physician is a good communicator leads to
2.16 times better patient adherence
RESPECT model
- Respect
- Explanatory model
- Social context
- Power
- Empathy
- Concerns
- Trust
R of respect model
- active listening posture
- non-verbal and verbal encouragement
- summarizing/paraphrasing
E of respect model
•ask about patient’s explanatory model:
“what are you most worried could be causing your symptoms?”
“what do you think might solve this problem?”
S of respect model
•ask about social context of illness/problem:
“how is this affecting your life?”
“what gives your strength to face your illness?”
P of respect model
•Share power
“is there anything else you’d like to talk about today?”
•Limit interruptions
•sit
E of respect model
•show empathy
NURS!
C of respect model
•ask about concerns/fears
T of respect model
•trust, team-building, therapeutic alliance
NURS
- name emotion
- seek to understand the reason for emotion
- respect/validate
- offer support
5 step interviewing
- set stage for interview
- obtain CC and other current concerns/ agenda setting
- open HPI
- continue patient-centered HPI
- transition to doctor-centered phase of interview
* conclude with summary, change to change or add, give instructions (ie wait here)
subjective data in patient hx
- patient’s story
* symptoms obtained in history from CC through ROS
objective data in patient hx
- what you discover in physical exam
- lab studies
- imaging studies
elements of complete medical history
- CC
- HPI
- PMH
- PSH
- Meds
- Allergies
- FHx
- SHx
seven dimensions of a symptom
LOCATES •Location •Other associated sx •Character (quality) •Aggravating/Alleviating factors •Timing •Environment (setting) •Severity
Location
- exact location
* does it radiate or change location
Timing
- onset
- constant/intermittent
- recurrent
- duration
- frequency
family hx
- parents, siblings, grandparents
* age of onset for FHx
social hx
- occupation/work setting
- habits - tobacco, alcohol, drugs
- diet
- exercise
- relationship/support
