{"id":79,"date":"2011-03-17T22:42:51","date_gmt":"2011-03-17T22:42:51","guid":{"rendered":"http:\/\/seragpsych.com\/wordpress\/?p=79"},"modified":"2015-08-27T00:11:05","modified_gmt":"2015-08-26T21:11:05","slug":"the-art-of-communiation-and-interviewing","status":"publish","type":"post","link":"https:\/\/seragpsych.com\/wordpress\/the-art-of-communiation-and-interviewing\/","title":{"rendered":"THE ART OF COMMUNICATION AND INTERVIEWING"},"content":{"rendered":"
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COMMUNICATION AND INTERVIEWING:<\/span><\/em><\/p>\n

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COMMUNICATION:<\/span><\/em><\/p>\n

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This should be adequate, accurate, understandable, imperative and satisfying the patient.<\/p>\n

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INTERVIEWING:<\/span><\/em><\/p>\n

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Magic skill…<\/span><\/em> to establish interaction, gather data and develop doctor patient relationship.<\/p>\n

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PRIMARY GOALS OF THE PATIENT INTERVIEW:<\/span><\/em><\/p>\n

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At the Beginning<\/p>\n<\/div>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n

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To establish rapport .\u00a0 You should<\/p>\n

\u00b7\u00a0 put the patient at ease<\/p>\n

\u00b7\u00a0 introduce yourself<\/p>\n

\u00b7\u00a0 show respect to the patient<\/p>\n

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During the interview:<\/p>\n<\/div>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n

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To Identify relative problems , you should<\/p>\n

\u00b7\u00a0 Allow the patient talk and express his feelings<\/p>\n

\u00b7\u00a0 Use proper language<\/p>\n

\u00b7\u00a0 use tact in framing questions<\/p>\n

\u00b7\u00a0 move effectively from one area to another<\/p>\n

\u00b7\u00a0 Use periodic sum<\/p>\n

\u00b7\u00a0 Clarify inconsistencies<\/p>\n

\u00b7\u00a0 Obtain meaningful information<\/p>\n

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At the End<\/p>\n<\/div>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n

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The patient should feel satisfaction. You should<\/p>\n

\u00b7\u00a0 Inform the patient for further steps<\/p>\n

\u00b7\u00a0 Give the patient opportunity to ask<\/p>\n

\u00b7\u00a0 Make closing statement.<\/p>\n

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CONTENT AND PROCESS OF AN INTERVIEW:<\/span><\/p>\n

CONTENT:<\/p>\n

Is the verbal exchange .<\/p>\n

PROCESS:<\/p>\n

Refers to what happens during the interview .\u00a0 The Physician should answer by himself 3 questions<\/p>\n

Why the patient is here?<\/p>\n

How he feels Now?<\/p>\n

His possible reaction to what is going on now ?<\/p>\n

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Characters of process of communication<\/span>:<\/p>\n

Fear\u00a0 may be expressed by momentary anger e.g. the patient may shout at the physician for being late\u00a0 probably he is afraid of\u00a0 being unavailable.<\/p>\n

Patient may speak about the present by recalling the past.<\/p>\n

Messages might hide ; but the patient passes remarks<\/p>\n

Gradual shifts of conversations<\/p>\n

Body languages<\/p>\n

Repetitions<\/p>\n

A.R.T.\u00a0 OF\u00a0\u00a0 INTERVIEWING:<\/span><\/em><\/p>\n

\u00b7\u00a0 A =ASSESSMENT<\/span><\/p>\n

Most\u00a0 of the questions are open ended and non directive .\u00a0 The patient describes, raises concerns and interests.<\/p>\n

\u00b7\u00a0 R =RANKING<\/span><\/p>\n

Ares to pursue further by direct questions so that each of the ranked problem can be investigated thoroughly according to its importance regarding the patient.<\/p>\n

\u00b7\u00a0 T =TRANSITIONS<\/span><\/p>\n

Interview should flow smoothly from one aspect to another and the patient should be at ease.<\/p>\n

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GUIDELINES FOR COMMUNICATION AND INTERVIEWING:<\/em><\/p>\n<\/div>\n

The best interview should be organised and structured to\u00a0 elicit as much information as possible.<\/p>\n

Developing an open and productive Communication:<\/p>\n

You should develop specific techniques in asking questions approached\u00a0 with sense of purpose comparison\u00a0 and curiosity.<\/p>\n

It should be friendly conversations and interrogation.<\/p>\n

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Personality characters of both the patient and physicians:<\/p>\n

Physicians should understand his own emotions , thoughts and reactions.<\/p>\n

Patients responses should be noted<\/p>\n

Emotional\u00a0 ( Laughing and crying).<\/p>\n

Motor \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 = Facial ( Smiling, nodding, frowning, sneering..etc.).<\/p>\n

Speech pattern ( Rate – volume and tone and what dose it mean?)<\/p>\n

Bodily gestures ( Clenching fists, fidgeting,<\/p>\n

Patient emotional response to illness.<\/p>\n

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TECHNIQUES OF COMMUNICATING:-<\/span><\/p>\n

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\u00b7\u00a0 FACILITATION<\/em>= Encourage the patient to ventilate\u00a0 how?Repeat last word, question look, as what, give me example, please more verification.<\/p>\n

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\u00b7\u00a0 OPEN ENDED QUESTIONS<\/span><\/em>= To have none specific informations.<\/p>\n

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\u00b7<\/p>\n

\u00b7\u00a0 DIRECT QUESTIONS<\/em> = To have specific information.<\/p>\n

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\u00b7<\/p>\n

\u00b7\u00a0 SUPPORT<\/span><\/em> = By giving him\/her interests and true will to help.<\/p>\n

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\u00b7\u00a0 EMPATHY= is to sympathize with the patient and to find a solution..<\/p>\n

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\u00b7\u00a0 REFLECTION= repeat , mirror, echo a portion of what a patient has just said.<\/p>\n

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\u00b7\u00a0 SILENCE=Brief, chance to express and explore more.<\/p>\n

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\u00b7\u00a0 CLARIFICATION= for further information ,clarify to the patient what is clear from his behaviour\u00a0 and reactions.<\/p>\n

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\u00b7\u00a0 CONFRONTATION=to call patient’s attention to his misbehaviour or good for depressed , inconsistent, and contradictions.<\/p>\n

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\u00b7\u00a0 SUMMATION=Review information<\/p>\n

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\u00b7\u00a0 INTERPRETATION= is a formulation of data , events and thoughts.<\/p>\n

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PHYSICIAN – PATIENT RELATIONSHIP <\/span> – FACTS AND THEORIES:<\/span><\/p>\n

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Definition:<\/span><\/em><\/p>\n

is a 2 person relationship in a social system<\/p>\n

It transcends the traditional bed side manner.<\/p>\n

The physician provides emotional support and legitimise the illness .<\/p>\n

It is an important mediator of the therapeutic effect of every ttt program. (Placebo).<\/p>\n

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The Sick Role:<\/span><\/p>\n

Societal Expectations or the Ground rules.<\/span><\/p>\n

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Exempted from normal social responsibilities.<\/p>\n

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Unblamable<\/p>\n

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Motivated to get well<\/p>\n

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Obliged to seek technically competent help.<\/p>\n

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Performance of the sick role:<\/span><\/p>\n

Economic:<\/span><\/em><\/p>\n

In case of hard financial aspects the patients are supposed to be reluctant to assume the sick role.<\/p>\n

Patients who are injured on the job, this may intensify and prolong the sick role.<\/span><\/em><\/p>\n

Students might be inclined to assume the sick role for fear of interpretation in their careers<\/p>\n

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Personal Experiences:<\/span><\/em><\/p>\n

Proper time to assume the role for personal reasons and secondary gain.<\/p>\n

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Societal view of a particular illness:<\/span><\/em><\/p>\n

This may affect the motivation for assuming illness role.<\/p>\n

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Psychological factors:<\/span><\/p>\n<\/div>\n

Personality type:<\/p>\n

Habitual patterns of thoughts, behaviour and feelings of individuals<\/p>\n

THERE ARE\u00a0 8 TYPES OF PERSONALITIES CAN VISIT YOU\u00a0\u00a0 :<\/p>\n

\u00b7\u00a0 Dependent, Demanding individuals<\/span><\/p>\n

Require a lot of reassurance and attentions , may enjoy their illness and sensitive to rejection.<\/p>\n

\u00b7\u00a0 Orderly controlling individuals:<\/span><\/p>\n

Need to control their external and internal environment, they display intense fear of being helpless.\u00a0 you should describe to them precisely, with little emotional reaction, they feel very threatened by the control that physicians assume over their lives.<\/p>\n

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\u00b7\u00a0 Dramatising and emotional individuals:<\/span><\/p>\n

Need for continuous reassurance that they are still attractive and won’t be abounded . Describe impressionistically and charming often behave covertly .<\/p>\n

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\u00b7\u00a0 Long – Suffering self sacrificing<\/span><\/p>\n

Endure\u00a0 protracted pain , they\u00a0 complaint of bad luck and disappointments and efforts of their physicians.\u00a0 they are mostly guilty.<\/p>\n

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\u00b7\u00a0 Guarded and\u00a0 Suspicious:<\/span><\/p>\n

Hypervigilant, overly concerned about being harmed and exploited and criticises.\u00a0 hardly trust physicians blame others for their illness.<\/p>\n

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\u00b7\u00a0 Superior and Special individual:<\/span><\/p>\n

Behave as VIP , grandiose , snobbish and arrogance , proud of themselves and seek most emollient physicians.<\/p>\n

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\u00b7\u00a0 Aloof and Seclusive individuals:<\/span><\/p>\n

Shy, remote and detached. They postpone the time to meet the physician alone.\u00a0 Respect their privacy and don’t too much intrude if they don’t like to.<\/p>\n

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\u00b7\u00a0 Impulsive:<\/span><\/p>\n

low frustration threshold and unable to delay gratification , they demand immediate relief of symptoms and act out aggressively.\u00a0 They may throw things of the physicians.<\/p>\n

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Personal Meaning of Illness:<\/span><\/p>\n<\/div>\n

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The patient may view the illness as<\/p>\n

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\u00b7\u00a0 A challenge<\/p>\n

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\u00b7\u00a0 Inherent weakness<\/p>\n

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\u00b7\u00a0 Threaten for destruction<\/p>\n

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\u00b7\u00a0 Punishment<\/p>\n

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\u00b7\u00a0 Strategy to cope with life demands.<\/p>\n

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\u00b7\u00a0 Relief from societal responsibilities<\/p>\n

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\u00b7\u00a0 Irreparable damage<\/p>\n

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\u00b7\u00a0 Positive Experience in the appreciation of the meaning of life and provides atheistic values.<\/p>\n

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METHODS OF COPING WITH ILLNESS:<\/span><\/p>\n<\/div>\n

This reflects both personality types and patient view about illness .<\/p>\n

Cognitive responses to illness:<\/p>\n

Minimization:<\/span><\/p>\n

Tends to ignore, deny, and rationalize significance of illness up to delusional denial of illness.<\/p>\n

Vigilant focusing:<\/span><\/p>\n

Brisk response to perceived danger signals.\u00a0 Anxious rumination and exaggerations.<\/p>\n

Behavioral Responses to Illness:<\/span><\/p>\n

\u00b7\u00a0 Tackling:<\/span><\/p>\n

active attitude towards challenge of illness .\u00a0 He uses the damaged part of his body as if it is present and in its optimum function.<\/p>\n

\u00b7\u00a0 Capitulation:<\/span><\/p>\n

Passivity i.e. fully give up.<\/p>\n

\u00b7\u00a0 Avoidance:<\/span><\/p>\n

flights into health and escape from sinking\u00a0 i.e. mixed from both above.<\/p>\n

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THE ROLE OF THE PHYSICIAN:<\/p>\n<\/div>\n

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\u00a8 SOCIETAL EXPECTATIONS:<\/span><\/p>\n

5 key aspects to the physician ‘s role:<\/p>\n

1-\u00a0 Technical competence:<\/p>\n

High updated and technical skilled also\u00a0 knowledgable.<\/p>\n

2- Medical Role:<\/p>\n

Universalism, the physician is liable to treat any patient even his enemy.<\/p>\n

3- Functional Specificity:<\/p>\n

Specificity of competence ( he chooses what he specifically skilled to do )<\/p>\n

Specificity of scope of concern ( Skills and knowledge\u00a0 is only directed to medical care).<\/p>\n

4- Affective neutrality:<\/p>\n

Treat equally.<\/p>\n

5- Collectively oriented:<\/p>\n

Aware by things going on..<\/p>\n

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\u00a8 PATIENT’S EXPECTATIONS:<\/span><\/p>\n

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The doctor\u00a0\u00a0\u00a0 1- Reliefs from the distress regardless of illness.<\/p>\n

2- An unhurried setting and atmosphere.<\/p>\n

3- Available\u00a0 ” MY DOCTOR”<\/p>\n

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\u00a8 PHYSICIAN EXPECTATIONS:<\/span><\/p>\n

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The patient perceived as good\u00a0 when he fulfill\u00a0 5<\/p>\n

1- Suffering by his symptoms.<\/p>\n

2- Presents objective symptoms and signs of treatable disease.<\/p>\n

3-Cooperates in treatment processes .<\/p>\n

4- No emotional demands on\u00a0 the physicians.<\/p>\n

5- Appreciating efforts.<\/p>\n

The patient is perceived as bad or blamed if one of the previous 5 is not fulfilled.<\/p>\n

the problems created mainly by the physician\u00a0 due to\u00a0 ineffective communication or deficient technical skills , knowledge and judgment.<\/p>\n

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MODELS OF THE PHYSICIAN PATIENT RELATIONSHIP:<\/p>\n<\/div>\n

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I-\u00a0 ACTIVITY – PASSIVITY:<\/span><\/p>\n

The prototype is that infant parent relationship<\/p>\n

The task is to define the illness.<\/p>\n

The role – the physician is sufficient and the patient has no role .<\/p>\n

The physician gratifies his own needs for technical skills<\/p>\n

Clinical Applications: as in delirium, comatosed, anaesthesia and immobilized.<\/p>\n

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II- GUIDANCE-COOPERATION:<\/span><\/p>\n

In most current medical practice.<\/p>\n

The task is to define illness and prescribe ttt<\/p>\n

The doctor is responsible and the patient helps.<\/p>\n

The doctor is fully licensed to design .<\/p>\n

The physician satisfies his needs of nurturing, protect and restore.<\/p>\n

Clinical Applications: as in infections and convulsence.<\/p>\n

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III- MUTUAL PARTICIPATION MODEL:<\/span><\/p>\n

This is a model of 2 adults interacting for business purposes.<\/p>\n

It provides the framework for illness and ttt , the patients view integrated with the physician.<\/p>\n

The physician is professional specialist with skills , the patient is perceived as expert and concerned.<\/p>\n

The physician leads but not order, the patient monitor and participate.<\/p>\n

It fulfils needs for discovery , and mastery over anxiety.<\/p>\n

Clinical Applications as in cases of D.M and D.S.<\/p>\n

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IV-SOCIAL INTIMACY :<\/span><\/p>\n

2\u00a0 close friends<\/p>\n

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STRESSES ON THE PATIENT – PHYSICIAN RELATIONSHIP:<\/span><\/p>\n

I- DIFFICULT PATIENTS:<\/span><\/em><\/p>\n

The difficult patient is the one who raises problems in relationship.<\/p>\n

1-Covertly self destructive:<\/p>\n

covertly suicidal, defeat the physician attempts to save lives<\/p>\n

endanger a sense of futility in the physician who may act with overt anger or covert wishes that the patient would die.<\/p>\n

Exampified by those with severe emphysema and continuous smoking<\/p>\n

2-Uncooperative patient:<\/span><\/p>\n

question treatment.<\/p>\n

Refuse testing and treatment<\/p>\n

Request another opinion<\/p>\n

Demands that hospital make concessions to their needs<\/p>\n

don’t get well<\/p>\n

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3- Somatizing patient:<\/span><\/p>\n

Have a long standing recurrent physical\u00a0 c\/os\u00a0 without significant underlying disease or physiological abnormalities.<\/p>\n

Psychologically their symptoms are stemmed to serve them!!\u00a0 How?<\/p>\n

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Intrapsychic conflict:<\/span> The alteration of guilt through suffering secondary\u00a0\u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 to chronic pain.<\/p>\n

Problematic Interpersonal relationship:<\/span> Refusal of sexual relations \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 because of recurrent headache.<\/p>\n

Social or Environmental Problems<\/span>: \u00a0Not returning to unpleasant jobs \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 because of continuing symptoms stemming from work related \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 troubles.<\/p>\n

The difficult patients are perceived by physicians as not truly patients on scientific bases , so they lead to physicians’ frustration and anger. \u00a0They are seeking with their physicians a key source\u00a0 of the respect, affection, concerns sympathy and love that they are not getting from parents, spouses , children or close friends .\u00a0 They are somatoform disorders<\/p>\n

Somatization disorder<\/p>\n

Conversion disorder<\/p>\n

Hypochondriasis<\/p>\n

Psychogenic pain disorder<\/p>\n

Factious disorder<\/p>\n

Malingering.<\/p>\n

4-patients with chronic Cognitive Impairment ( Chronic Organic Brain Syndrome):<\/p>\n

Those are uncooperative , negativistic and fail to perform mental state examination.<\/p>\n

Those patients may be dehumanized.<\/p>\n

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5-Physicians as patients:<\/span><\/p>\n

induces more stress .<\/p>\n

They choose physicians with whom they may not lose equality.<\/p>\n

custom issue<\/p>\n

treating physicians may be reluctant to ttt physicians<\/p>\n

treating physician may fear criticism of his knowledge.<\/p>\n

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DIFFICULT CLINICAL ISSUES:<\/span><\/p>\n

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1-PAIN:<\/span><\/p>\n

development of rapport and trust between the patient\u00a0 in pain and physician may be impeded due to<\/p>\n

Underprescribing as the physician fear to turn the patient to an addict<\/p>\n

If it is not functional may not take attention, respect, interest and reacts with resentment, anxiety .<\/p>\n

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2-DYING:<\/span><\/p>\n

Helping this patient to accommodate to death , the physician usually avoid, the physician may uncomfortably about informing the patient .<\/p>\n

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3- The patient with CONSENT<\/span><\/p>\n

The informed consent refers to patient right to choose .<\/p>\n

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4-SEXUALITY;<\/span><\/p>\n

Physician fear asking about sex aspects so he leaves unclosed data.<\/p>\n

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TRANSFERENCE AND COUNTERTRANSFERENCE:<\/span><\/p>\n

 <\/p>\n

I- TRANSFERENCE:<\/span><\/p>\n

Unconscious projection presents feelings about attitudes linked to important people in the patient ‘s early life ( Parents and siblings )onto someone\u00a0 ( the physician).\u00a0 When intense it introduces distortion that interfere with effective working alliance between physician and patients.<\/p>\n

Patient may reactivate an infantile need for none demanding gratifying omnipotent parent.<\/p>\n

Repressed negative feelings<\/p>\n

Negative transference reactions(hostility, suspiciousness, and competitiveness).<\/p>\n

 <\/p>\n

II- COUNTERTRANSFERENCE:<\/span><\/p>\n

Physicians misperception of and inapporpiate\u00a0 behaviour toward patient. stemmed from unconscious emotional determined responses\u00a0 ( Unconfident doctor since childhood, thinks that all patients are revising him;\u00a0 doctor wants all patients love him and he seeks to do ultimate impossible help to them; doctor wants to alleviate the childhood pain …etc.<\/p>\n

 <\/p>\n

It is expected when?<\/p>\n

the doctor has intense feelings ( anger, guilt, sexual attraction ) toward patient.<\/p>\n

Feels drowsy, bored , unconcerned , unable to empathize, vulnerable to criticism from the patient.<\/p>\n

becomes inattentive to the patient.<\/p>\n

Argues\u00a0 with the patient<\/p>\n

Dreads from the patient visits.<\/p>\n

Feels that the patient is unappreciating<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

                COMMUNICATION AND INTERVIEWING:   COMMUNICATION:   This should be adequate, accurate, understandable, imperative and satisfying the patient.   INTERVIEWING:   Magic skill… to establish interaction, gather data and develop doctor patient relationship.     PRIMARY GOALS OF THE PATIENT INTERVIEW:   At the Beginning       […]<\/p>\n","protected":false},"author":1,"featured_media":83,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[456,6,5,152,458,151],"tags":[],"class_list":["post-79","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-456","category-6","category-5","category-152","category-458","category-151","entry"],"_links":{"self":[{"href":"https:\/\/seragpsych.com\/wordpress\/wp-json\/wp\/v2\/posts\/79","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/seragpsych.com\/wordpress\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/seragpsych.com\/wordpress\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/seragpsych.com\/wordpress\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/seragpsych.com\/wordpress\/wp-json\/wp\/v2\/comments?post=79"}],"version-history":[{"count":8,"href":"https:\/\/seragpsych.com\/wordpress\/wp-json\/wp\/v2\/posts\/79\/revisions"}],"predecessor-version":[{"id":6154,"href":"https:\/\/seragpsych.com\/wordpress\/wp-json\/wp\/v2\/posts\/79\/revisions\/6154"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/seragpsych.com\/wordpress\/wp-json\/wp\/v2\/media\/83"}],"wp:attachment":[{"href":"https:\/\/seragpsych.com\/wordpress\/wp-json\/wp\/v2\/media?parent=79"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/seragpsych.com\/wordpress\/wp-json\/wp\/v2\/categories?post=79"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/seragpsych.com\/wordpress\/wp-json\/wp\/v2\/tags?post=79"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}