Communication with surgical patients (Surgical history taking) Prof. Galal Abouelnagah, FRCS, PHD,...

Communication Communication with surgical with surgical

patientspatients(Surgical history taking)(Surgical history taking)

Prof. Prof. Galal AbouelnagahGalal Abouelnagah, FRCS, , FRCS, PHD, MDPHD, MD

Prof & head of Surgical Oncology unitProf & head of Surgical Oncology unit

Faculty of MedicineFaculty of Medicine

Alexandria UniversityAlexandria University

ObjectivesObjectives

Define effective history takingDescribe components of patient historyOutline patient interviewing techniquesIdentify strategies in obtaining historyTechniques facilitating History TakingSpecial challenges

What is it?What is it?

Patient interview in systematic way to:Patient interview in systematic way to:Recording necessary medical Recording necessary medical

informationinformation

+ Classical examination signs+ Classical examination signs

All information must be documented precisely and accurately

ImportanceImportance

Help for reaching diagnosisHelp for reaching diagnosisHelp in formulation treatment planHelp in formulation treatment planEvaluate medical progressEvaluate medical progressMedico-Legal recordMedico-Legal recordAvailability of information for:

ResearchReportable diseasesInsurance claims

ExampleExample

. . مدة من معايا بدأ والتعب دكتور يا جدا تعبان . أنا . مدة من معايا بدأ والتعب دكتور يا جدا تعبان أنا . تشوف عاوزك روشتة لى كتبوا كثيرة لدكاترة . رحت تشوف عاوزك روشتة لى كتبوا كثيرة لدكاترة رحت . . كله مستحمل عدتش ما و تعبت خالص أنا حل . لى . كله مستحمل عدتش ما و تعبت خالص أنا حل لى

. خالص. أعيش عارف مش .بيوجعنى خالص. أعيش عارف مش بيوجعنى

What the disease of that patient?What the disease of that patient?Which body system is affected?Which body system is affected?Since when disease started?Since when disease started?What treatment he received & does it What treatment he received & does it

help?help?

Types of patient interviewTypes of patient interview

Initial history takingInitial history taking Inward daily round: progress of Inward daily round: progress of

condition, results of investigations, condition, results of investigations, respond to treatmentrespond to treatment

Discharge interview: plain at homeDischarge interview: plain at home Follow up visit: New symptoms & signs Follow up visit: New symptoms & signs

since last visit, drug managementsince last visit, drug management Field research or screening questionnaireField research or screening questionnaire

Not just completing a formNot just completing a formTell patient your name and explain Tell patient your name and explain

why you are seeing himwhy you are seeing him

More important for medical studentsMore important for medical studentsCould be started before patient’s talkCould be started before patient’s talkGive patient whole your attentionGive patient whole your attentionDoctor should be an empathetic Doctor should be an empathetic

listenerlistener

General rulesGeneral rules

Consent Consent

Type of consents: Type of consents: • OralOral• BehavioralBehavioral• Written consent Written consent

Why:Why:• To get adequate information about case To get adequate information about case • Avoid medico-legal complainsAvoid medico-legal complains

Set the stageSet the stage

Provide safe environmentProvide safe environmentYour behavior and appearanceYour behavior and appearanceShake handsShake handsAvoid the patient’s personal spaceAvoid the patient’s personal spaceInquire about patient’s feelingsInquire about patient’s feelingsAvoid unfamiliar or street termsAvoid unfamiliar or street termsNote takingNote takingSigns of uneasinessSigns of uneasiness

(Body Language(Body Language ) )

Significance Action االرتياح أو الرضا أو

الموافقةاإلبتســــــــ  

ــامــــه . العصبية أو الغضب

.أو الضيق

قضــــــــــم .الشفاه

المفاجأة أو عدم

التصديق أو الدهشة

رفع الحواجب مع

أو الكتف .

التهكم أو .السخرية

رفع مع الحواجب

ابتسامه مصطنعة

عدم الموافقة أو

الشعور لسلبى ا

تضييق العـــــــــــين

االهتمام أو العناية .

االنحناءلإلمام

القلق أو السأم أو التعب

الحركة الكثيرة فى الجلسة

االستقامة الثقة بالنفس . واالعتدال

.الجلسة فى

اإلنصات أو تركيز

االنتباه

تركيز العين فى عين

الطرف اآلخر التجنب أو

الالمبــــاالة أوالعصبية.

تجنب تالقى . األعــــين

. التثــاؤب الملل والضجر .

Guidelines for taking case Guidelines for taking case historyhistory

Questions should be open ended (encourage)Guidance of conversation but not restrictingAvoid leading questions (‘yes’ or ‘no’ answers)Clear & specific questionsAsk one question at a timeCover various aspects of diseased organDirect questions may be required sometimesPatient symptoms in his own words??

Special situationsSpecial situations

Infants under 5yrs; parent is Infants under 5yrs; parent is interviewedinterviewed

Unconscious patientsUnconscious patientsUnder drugs effectUnder drugs effectShying patientsShying patientsEmergency situationEmergency situation

In EmergencyIn Emergency

Fast the procedure but do not ignore Fast the procedure but do not ignore itit

In case of emergency, obtain In case of emergency, obtain information from patient and/or information from patient and/or bystandersbystanders

Classical history takingClassical history taking

Personal dataPersonal data Name:Name:• Full, accurateFull, accurate• Communicate with patientCommunicate with patient• Medico-legal aspectsMedico-legal aspects

Age:Age: • Date of birth is betterDate of birth is better• Growth and development is notedGrowth and development is noted• Certain diseases correlated with ageCertain diseases correlated with age• Management techniques according to ageManagement techniques according to age

Sex:• Some diseases shows sex predilection• Ethics & religious consideration

Marital status: Infertility, pregnant…

Contacts:• Address: endemic diseases, follow up visits• Phone• Nearest kin

Personal dataPersonal data

Occupation: Socio economic status

Race: Some certain diseases

Religious: Certain considerations

Date & type of admissionHospital number

Personal dataPersonal data

Chief ComplaintChief Complaint

First symptoms that caused First symptoms that caused patient to seek medical advicepatient to seek medical advice

Often:Often:PainPainBleedingBleedingAbnormal functionAbnormal functionObservation of a lumpObservation of a lump

Many complaints Always record patient’s own words In order of severity In chronological order

Present History Def.: Details of symptoms & their progress Should be well organized, clear, detailed

It is important to get right back to the beginning of the problem

Present History

Etiology (predisposing factors)

Classical course of disease

Any complications

Loco-regional effect

Systemic effect

Present historyPresent history

Negative information should be Negative information should be included if they contribute to the included if they contribute to the diagnosis or help exclude other diagnosis or help exclude other possibilitiespossibilities

Past & medical history

Past & medical history• AAllergy & anemiallergy & anemia• BBleeding disorders leeding disorders • CCardio respiratory disordersardio respiratory disorders• DDrug historyrug history• EEndocrine disordersndocrine disorders• FFits & faintsits & faints• GGastrointestinal disordersastrointestinal disorders• HHospital admissions & surgeriesospital admissions & surgeries• IInfectionsnfections• JJaundice & hepatic diseaseaundice & hepatic disease• KKidneyidney

Ask about health or cause of death of Ask about health or cause of death of patient’s parents, grandparents, brothers patient’s parents, grandparents, brothers and sistersand sisters

Previous similar illnesses in the familyPrevious similar illnesses in the family

Potential for hereditary diseasesPotential for hereditary diseases

Family historyFamily history

Reproductive historyReproductive history

Infertility of both sexes Infertility of both sexes Gynecological causes of abdominal Gynecological causes of abdominal

painpainPregnancy & lactationPregnancy & lactationAlso ask about:Also ask about:

Contraceptive useContraceptive useVenereal diseaseVenereal disease

Habits Habits

SmokerSmokerAthleticsAthleticsAppetiteAppetiteAlcoholAlcoholCoffeeCoffeeSexualSexual

Sensitive TopicsSensitive Topics

Alcohol or drug abuseAlcohol or drug abuse

Physical abuse or violencePhysical abuse or violence

Sexual issuesSexual issues

Psychiatric problemsPsychiatric problems

Sensitive Questions GuidelinesSensitive Questions Guidelines Respect patient privacyRespect patient privacy

Be direct and firmBe direct and firm

Avoid confrontationAvoid confrontation

Be nonjudgmentalBe nonjudgmental

Use appropriate languageUse appropriate language

Document carefullyDocument carefully Use patient’s words as possibleUse patient’s words as possible

Special ChallengesSpecial ChallengesSilence # overly talkative patientsSilence # overly talkative patientsPatients with multiple symptomsPatients with multiple symptomsAnxious patientsAnxious patientsAnger and hostilityAnger and hostilityCrying & depressionCrying & depressionConfusing behavior or historiesConfusing behavior or historiesLimited intelligenceLimited intelligenceDevelopmental disabilitiesDevelopmental disabilities

Barriers to CommunicationBarriers to Communication

May result from:May result from:Social or cultural differencesSocial or cultural differencesSight, speech, or hearing impairmentsSight, speech, or hearing impairments

Attempt to find assistance to aid in Attempt to find assistance to aid in communicationcommunication

Patient encouragesPatient encourages

Let patient continue talkingLet patient continue talkingFACILITATIONFACILITATION

““Tell me more about it”Tell me more about it”“ “ Please go on”Please go on”““I’m interested to hear about it “I’m interested to hear about it “

Rocking:Rocking: “Yes, Uh huh, umm, I “Yes, Uh huh, umm, I see”see”

Repeating:Repeating: ”It usually happens at ”It usually happens at night?”night?”

ConfirmationConfirmation

ClarifyingEx: “What do you mean by fretful?”

“Do you mean this . . . . ?”

خاطبوا الناس على " "قــــــدرعقولهم

Explain to the patients what is going onExplain to the patients what is going onEncourage patient to ask questionsEncourage patient to ask questionsNext plainNext plain

Thank the patientsThank the patientsDate & signatureDate & signature

FinallyFinally

Do notDo not

False quick diagnosisFalse quick diagnosisMalignancyMalignancyDebilitating diseaseDebilitating disease

False reassuranceFalse reassuranceMay be tempting May be tempting Avoid early assurance or “over Avoid early assurance or “over

reassurance” reassurance” Unless it can be provided with confidenceUnless it can be provided with confidence

Thank you….!Thank you….!

Any Questionswww.med.alexu.edu.eg/soncology