Physical exam normal findings9/16/2023 ![]() ![]() Ask yourself, "Why did this patient come?" There may be hidden anxiety such as a concern about cancer that needs to be explored and addressed. In a patient-led interview, staying focused can be a challenge. It is worth noting that research has shown that on average, physicians tend to interrupt a patient within 16 seconds of asking an opening question, whereas allowing them to speak uninterrupted may take an average of just six seconds longer. If their greatest concern is not worrying you, jot it down and make sure you address it at the end of the consultation (even if it is just to reassure them). The two may not be the same but each is important. Note that the first addresses the patient's concern, whereas the second addresses yours. Tell me a little more about the shortness of breath. Tell me which one of these problems is troubling you most?" This may pose a challenge in the time-pressed clinic when confronted with a chatty patient who finds it difficult to give a clear history - in these cases, gentle steering phrases may be helpful: We are encouraged to ask open questions and avoid leading questions. The returning patient who needs endless reassurance.The angry patient whose wait for the appointment or in the waiting room has given them time to mull over the worst.The apparently over-confident patient who addresses (or adds to) their anxiety by turning up with an armful of internet printouts, concerned that they have been fatally afflicted by Von Noodles' disease.The quiet patient from whom only monosyllabic answers can be extracted by direct questioning.This may manifest itself in a number of ways: Patients vary greatly in how they present. If they have had to wait a long time, a comment addressing this with an apology at the outset is often appreciated it will give you a much better start and shows respect for their individuality.Īvoid writing whilst the patient is talking to you if they are saying a lot of relevant things - or there is importance in the temporal order of the narrative - and you need to jot them down, mention it to the patient so that they understand that you are still listening to them: "I'll just make a note of your symptoms as you go along so that I get the order right." Extracting the information Be relaxed and smile to radiate confidence. Your manner, your physical position with regards to the patient's (this may not be within your control), and your body language all contribute to the outcome of the consultation. Remember that these are non-verbal as well as verbal. "Always listen to the patient, they might be telling you the diagnosis." Attr. There are risks and benefits to both these approaches, and you will need to rely on your clinical judgement in coming to a decision. If the consultation is over-running you will need to decide whether this is permissible (bearing in mind your obligations to other patients waiting to see you) or whether you need to ask the patient to return for another consultation. So it is important to be efficient and focused. Secondary care also benefits from a referral letter, whereas if you have a patient who is unfamiliar to you, you may have to extract a clear and concise story in a brief duration. Hospital consultants may allow up to an hour for new patient consultations, whereas general practice generally allocates a total of 10 minutes for history, examination and explanation (you are doing very well if you manage to fit in some health promotion). It is certainly worth noting the last consultation and the major problems as displayed on the screen. Patients expect you to know their past medical history, even if it is the first time that they have consulted with you, because they know that you have the records. Glance through the records before seeing the patient.Clear your mind of the last patient as you wash your hands to prepare for the next.This is a frequently neglected area but it can be very important. ![]()
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