Communication Skills: A Patient-Centered Approach

come in Miss Bellamy yes hi kind of um hear us I'll be your doctor today um let me just wash my hands really quick um would you prefer Miss Bellamy or would can I call you Pat Pat's fine great well it's nice to meet you nice to meet you um can you tell me why you're here today I have a terrible headache looks really bad um yes is there anything anything else besides your headache that you want to address here today at the clinic appartment no just that except I am concerned I just recently changed

insurance companies and I'm not sure this is going to be covered yet all right um was there anything um because uh what we can do is while we're talking and I'm doing your history and physical um I will have my office secretary looking the insurance plan that you have all right so you don't have to worry about that that sounds good okay sounds great um is there anything else no I just this is just really bad okay okay so what I'd like to do today and um is let's let's take a look at what's causing

your headache um I will go over history physical and then um we'll do again a physical exam and then we will look into your insurance policy and make sure that's all okay you know taking care of that sound like a good plan for you that's that's good perfect um so tell me a little bit more about this the head head pain that you're having well um it started about 3 days ago and um uh uh nothing has helped it it's it's just laid me flat I um haven't been able to go to work um it's

um nothing's helped I I um it's it's all over um I it really bad when I move so I'm trying not to move too much and the light is bothering me a lot okay um and unfortunately I can't dim the lights in this room but so I'll try to go quickly and um would it be okay if I took some notes oh sure all right so you said this headache started about 3 days ago okay um was there any um anything that brought it on anything unusual that happened maybe three days ago not really no

okay um can you tell me uh anything that makes it better is oh nothing's made it better I I took some Tylenol I tried Motrin nothing um I just try not to move too much all right um is there anything that makes it worse yeah like movement um and and light okay and um it's just constant though there's you know it doesn't it's just constant it's it's all over okay um so if you had to rate on a Pain Scale um zero being no pain 10 being the worst pain you ever had oh it's a

10 a 10 I've never had a headache like this okay yeah that sounds really bad um now as far as radiation does it move does that you said the head the pain is all up it's kind of all over um but it also I've got this shooting pain down my neck and my neck is is very stiff okay um but it's not it's it's it's the entire head entire head okay yeah um as far as in the in the timing you said that started three days ago but is it you said is a constant yeah

it it it started gradually but once once it got there it's hasn't gone away it doesn't get better it doesn't get worse it's just the same okay um so do you what I want to get is your perception of what you think is going on I don't know I just I can hardly think it's so painful I I just um because it's so bad I was afraid um my neighbor um had a headache and ignored it last year and uh he suddenly started having seizures and it turns out he had a um a brain tumor

so I thought I I just should come in and yeah I can understand your concern um what how is it impacting your daily life I can't go to work um uh I can't do anything yeah um so it sounds like it's really impacting your life yeah I can't um if it's okay I would like to go so talk about a little bit about your medical history and your social history all right um can you tell me as far as your medical history have do you have any medical conditions I should be aware of um not

um I was diagnosed with high blood pressure about three years ago but uh we've been addressing it with diet changes and been monitor yeah I go in yearly I had been just and it's been well controlled so okay great I haven't been on medication but other than that I haven't had any problems okay um any surgical history no um any hospitalizations no all right um and you said you're um the only medicine you're taking was the talent on law train yeah and they didn't help yeah okay just wanted to verify um do you have any

drug allergies uh no no okay um what about family history um do you have any medical history of headaches or in my family right um you know my mom said she used to get migraines when she was in her 20s and 30s um okay but I don't remember her saying anything else about it my sister uh I have one sister she's she's healthy my dad uh he has high blood pressure other than that he's healthy and um that's about it I don't I don't have any kids all right um it's all right I would like

to ask you some social History questions that um just for there are records um do you smoke uh yeah I do okay um is it um cigarettes or chewing yeah and how much do you smoke about a half a pack a day okay uh what about alcohol I don't drink okay um also um are you married yeah I'm married okay and children no okay and um just uh some some just some additional questions is um um looking at kind of gy in history are you um less menstrual period oh I'm in menopause okay yeah um

so going back into the history again um have you um you said your mom had migraines um earlier on um have you been around and you know other you haven't been nauseous or have you been yeah there I've been nauseous um okay uh in fact I threw up twice early on okay uh because when I move it makes me nauseous okay um nothing out of the ordinary over the past couple weeks have you been on any trips or anything or actually a week ago I was in um North Carolina for a family reunion okay and

there was a four-year-old who was sick there I I don't know what they had but they I guess I guess they ended up taking them into emergency know um so let me just so summarize to make sure I've got everything straight so far is um you started an onset of a severe headache about 3 days ago um it's worse with movement light really makes it hurt bad um it's a 10 out of 10 pain and you're also complaining of a stiff neck with that yes um it came on gradually and it's been constant pain in

the frontal area um medical history you're in hyper you have high blood pressure but that's um controlled with diet uh no surgical history no ear hospitalizations um the pain though is really impacting your day-to-day living and daily life um you to tried Tylenol mult it didn't help otherwise no medications um you've got the family history of your mom with migraines otherwise you're um family is healthy yeah U you smoke about a half a pack a day you don't drink um and then you were you you said you took a trip about a week ago or

two weeks ago yeah okay a week ago yeah I don't know it was in North Carolina all right um yeah I can understand your concern you about your friend you said that was having seizures um I've just never had this kind of pain before yeah and I can understand that and you know um so what I would like to do is um we've pretty much gone over your the history what I'd like to do is uh complete a physical exam okay um do some testing all right um and I want to ask too if there's

any other concerns I need to address um before we get to that final exam okay that that sounds good okay sounds great okay all right hi I'm Deb I'm your standardized patient nice job um I'm going to uh give you some feedback on your communication skills uh in this encounter but before I do how did you feel it went um I pretty good I was I was nervous at first I think and um just trying to make sure that um I was getting all your patient information so we could you know make sure we got

the correct tests and yeah you know yeah how did you feel when when you walked in you feel pretty comfortable uh I think I got more comfortable as we sat down and got to talk I could see that yeah good okay um well I thought you did a a nice job uh you had an appr introduction uh introduced yourself for some last name shook hands um I think you have a very warm demeanor and you're comfortable uh which uh makes me as a patient comfortable you did um ex uh elicit my chief complaint and asked

about any other concerns and that's when I told you I was also concerned about my insurance so that was another thing on the agenda so you did set a mutual agenda asked me if I agreed and so we had a clear road map going forward so you did um you hit all those real well you your first question tell me about this pain or um that was a nice open-ended question so allowed me to then tell my story um followed up with some more um pointed questions just for clarification on um and you had you're

an active listener had good contact eye contact and um could do a little bit more um uh reflective listening um just to little points where you could verify um check for accuracy maybe paraphrase as as I'm going through through um you did a nice summary uh in the middle that's good but just a little bit more reflection on that to let me know as a patient that you're hearing me um you asked my perspective of what I thought was going on and then you got the story um of M fear that maybe I've got a

brain tumor oh no yeah so um I thought you had nice flow logical U uh sequence of questioning um little bit of sign posting We just covered this and now we're going to do that I I heard that once um and as these um interviews get longer you're going to want to signpost between each um section I've taken your history now I'd like to go into um a a physical exam kind of thing um did a nice summary in the middle uh you move through quickly so you attended to um the timeline you did ask

permission permission to ask some um uh social questions maybe you want to mention um social questions may not be a flag for me that this is this could be personal or uncomfortable maybe I'm going to ask a little more some personal questions here is that all right with you just so I'm social question sounds fine to me until you start asking something that might sound personal so you might use the word some more personal perfect questions here uh not non-judgmental didn't you know didn't bad an I when when I said I smoke half a pack

um you have nice uh vocal range eye contact UM comfortable demeanor so uh that um felt real good and then um you uh did a summary uh at the end and um asked did you ask do anything else okay so anything else before um we do a physical exam so it was very nice nice encounter well thank you so much uh nice meeting you you to