Attributes of CAGE
Cutting down
Annoyance when criticized
Guilty feelings
Eye opener
Name cues of Sexual Abuse
- Physical exam inconsistent with hx of injury or injury concealed
- Delayed treatment
- Frequent “accidents” or “clumsy”
- Partner really unwilling to leave exam room, does all the talking
- Fear of pelvic or close contact; genital/rectal trauma or pain
- Hx repeated vaginal infection or STDs
- Young age 1st coitus or 1st IUP
- Young age 1st coitus & multiple partners
- ETOH or substance dependence
How does the clinician prepare for the therapeutic interview?
- Review overall daily schedule
- Review each record prior to entering room
- Mindset based on CC
How does the patient prepare for therapeutic interview?
List concerns
How does admin prepare for the interview?
- Policy
- Guidelines
- Protocols
Types of questions NOT to ask
- Yes/No questions
- Jargon questions
- Leading questions
What 3 things impact the general therapeutic interview sequence?
- Perspectives
- Expectations
- Preparation
What are expectations of a Clinician?
- Obtain attributes & relevant hx about symptoms
- Perform appropriate PE
- Formulate DDX
- Devise treatment plan & do so in timely fashion, flow of the visit
What are exceptions of a Patient?
- See some one who is knowledgeable
- Makes feel comfortable, heard & validated tend to the immediate concern
- Respect their time schedule
What are exceptions of the Admin?
- No disgruntled pt
- No complaints/legal issues/malpractice, maintain volume with little schedule flexibility
Components for a successful therapeutic interview
- Verbiage
- Flip the order of expectations
- Clinician skills: process with skilled questioning, rapport and empowerment, and partner/facilitator relationship
Attributes of Skilled Questioning
- Active listening, empathetic responses, guided questioning
- Stigmatization
- Transitions
- Non-verbal language
Attributes of Patient rapport and empowerment
- Validation
- Reassurance
- Partnering
- Cultural humility
Name the types of Guided questioning
- Open ended questions
- Elicit graded response
- Series, Multiple Choice option
- Clarification, continues
- Echoing
Give an example of an Open ended question
“How can I help you today?”
“What brings you into the clinic today?”
Give an example of an Elicit graded response?
“How many steps can you take before you need to rest?”
“How long can you — before fatigue?”
Give example of a multiple choice question?
Is the pain aching, sharp, shooting?
Example of a Clarification question?
“What do you mean by flu? By cold?”
Contunuers
Non-intrusive encouragement for pt to continue talking; “Go on”; “Uh huh”
Echoing
Repeat pt’s last few words = reflective technique
Non-verbal
- Eye
- Facial expression
- Neutral or at ease (posture, head position, movement).
Summarization
Recap of the facts by the clinician
“Let em make sure I’ve got this right”
Transitions
- Explains purpose of ROS
- Can allay pt fears of being singled out
- Allow for pt to defer or opt out
What are components of sensitive topics?
Sexual habits
Behavioral health or addiction
IPV, domestic violence, sexual assault
Terminal disease
