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Category: Interviewing

HOW TO ACCESS THE HUMAN SIDE OF MEDICINE

HOW TO ACCESS THE HUMAN SIDE OF MEDICINE

A patient presents with respiratory distress and COPD. She is very dramatic in her gestures, very upset and emotional. The first time you saw her you had given her lorazepam and sent her home. It turns out she frequently gets that. You and your colleagues eventually set boundaries on that but she continues to present daily for respiratory distress. This case turns out to involve the deeper human side of medicine. How do you access that?   How do we…

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HOW TO GET PATIENTS TO TELL THE TRUTH ABOUT DRUGS

HOW TO GET PATIENTS TO TELL THE TRUTH ABOUT DRUGS

Patients often lie about drug use and that can interfere with care. Part of practicing emergency medicine is using skill in communication to get through those communication pitfalls.   To get patients to tell the truth on drug use, start with asking about past use. Then ask current.   Furthermore, sometimes it helps to ask the question specifically In my area, I tend not to ask “do you use drugs?” I ask “did you try amphetamines when you were younger?”…

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IDENTIFYING AND ADDRESSING PATIENT CONCERNS: AGENDA SETTING

IDENTIFYING AND ADDRESSING PATIENT CONCERNS: AGENDA SETTING

It is possible to adequately address a chief complaint but not identify or meet the patient’s concerns. Agenda setting is defined as that process of the medical encounter where the doctor and patient agree on the plan for the visit. If agenda setting is not done, it defaults to whatever the doctor thinks is needed, and sometimes patients feel their concerns were not addressed. Interpersonal skills are often portrayed as something we do in addition to our normal duties. The…

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MEDICAL INTERVIEW: HOW TO ELICIT ALL OF THE PATIENTS SYMPTOMS

MEDICAL INTERVIEW: HOW TO ELICIT ALL OF THE PATIENTS SYMPTOMS

Studies show that patients omit symptoms when explaining their history to the doctor. I see this in academics when I get a story that adds information compared to what the resident elicited. When I observe resident history taking directly, I sometimes can gain insight into optimal and suboptimal medical history taking. Interruptions can be well-intentioned, but studies show they may prevent the patient from giving all the symptoms. Patients get off track and never finish. I recommend starting with a…

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