Subject: Friend, 10 Awkward Patient-Physician Interview Moments

Hello Friend,

When you become a doctor, it’s no secret that you will have to deal with people all day long.
And, in the course of these many human interactions (sometimes under stressful circumstances),
there are bound to be some awkward, uncomfortable and painfully silent moments. 
 
Here’s a list of the top 10 awkward patient-doctor moments:
 
1. Drawing a blank on an easy question. Maybe your mind is somewhere else,
maybe you were on call and didn’t get much sleep or maybe you simply can’t
remember the answer—but whatever the reason, drawing a blank in front of a
patient is awkward (especially on an easy, routine question) and sure to result in
a couple moments of uncomfortable silence.

>> Solution: Memorize sets of history taking questions and be on autopilot mode, 
just like when you drive a car. You don't think when to signal or turn or shift gears!
you drive on auto pilot mode.
 

2. Calling a patient by the wrong name. Calling a patient by the wrong name
is bad enough, but it becomes really awkward if the patient says something like,
“Are you sure you are giving me the right medication?” or “Are you sure you are
in the right room?” This one mistake may make them question everything during the visit!

>> Solution: Memorize an ethical friendly answer and use this mistake to build rapport.
Don't mention it as if you made a mistake. Say;
"As we are already here, let me see you first. I already saw your chart. Let me verify some information".
and continue as usual.
 

3. Mispronouncing a patient’s name. The level of awkwardness here depends largely
on how bad you butcher the name and whether the patient is used to it. Either way,
the patient will have to correct you, which can be somewhat uncomfortable.
This is why I will never try to pronounce a name I don’t know – I’ll ask them to pronounce it for me!

>> Solution: You should always call patients in a questionable tone, in order to verify identity and
pronunciation of a patient's name.

 
4. Flatulence (enough said). I could get really graphic on this one, but for your sake,
I won’t. Instead, I will simply say that when patients have unintentional “emissions”
of any kind during exams, it can cause a bit of embarrassment for both parties.

>> Solution: Act normally. When the patient apologize, say "It is totally Okay, never mind." and

continue with the interview. 
 
5. When a patient hits on you. Whether it is borderline sexual harassment by a senior citizen,
an inappropriate comment about your appearance or an invitation to dinner, this can cause
extreme weirdness that can extend long into the doctor-patient relationship.

>> Solution: Say "Let us focus on the cause of you being here. By law, I am not allowed to have any
relationship with you other than the professional doctor-patient relationship."


6. When you make a silly mistake. Suppose your patient has a problem with his left knee
and you begin examining the right. Of course, your patient has to say something …
which can result in embarrassed laughter and discomfort.

>> Solution: Say "I always like to test the “good” side first, for comparison and to keep the discomfort
for the end".
 

7. When a patient says something unexpected. Patients often say strange/funny things.
When a patient says something like, “When I drink too much alcohol, I throw up and my
head hurts the next morning,” it can be difficult to know how to respond.

>> Solution: This is a clue for what is important for the patient. It may be time to
start asking the CAGE questions, and counsel.

 
8. Dropping/spilling things. Although this is a little awkward for every doctor, it can be
especially awkward for surgeons who are expected to be steady-handed.

>> Solution: Say: "I am sorry for that. I was focusing on your condition and didn't notice that".
Clean up as much as you can specially what is affecting the patient.


9. When patients make inappropriate/off-color jokes. This happens ALL the time.
A patient’s jibe about their own demise or health condition, self-deprecating humor,
sexual innuendo or other crude/racist/culturally insensitive comments can render
a doctor speechless in seconds.
 
>> Solution: If the comment is about them; say: "Don't say that. Let us stay positive."
If the comment is about you; firmly say: "I am a licensed physician here and that definitely means
that I am as eligible as other physicians".


10. Asking for help with personal problems. Patients sometimes ask for inappropriate
help with personal problems (i.e. telling a family doctor “I need to break up with my boyfriend,
but I don’t know what to say”). 
 
>> Solution: Say: "I am not the right person to ask. Would you like me to arrange for you to seen
someone who can help you with this issue?" Referral to a social worker/therapist,


Although these awkward moments may cause discomfort at the time, they provide excellent fodder for stories and can give you and good laugh for years to come.


OSCE stations, similar to real life patients’ interviews, have limited time.  Physicians have no choice but to be focused and to organize the interview in a time efficient manner. The reality is that physicians have no time to listen to their patients. On the other hand, physicians have to be vigilant not to miss anything!

Obviously, there is a need for some sort of an approach that will fulfill both patients and physicians goals. An approach that will explore all the patients’ presenting issues in a limited time frame. An approach that will protect both the patients and physicians.

 

Since 2004, OSCEhome developed a Systematic Approach flowcharts that helps you master these two aspect specifically....
 

OSCEhome Systematic Approach

The solution is to memorize a set of history taking questions and to do physical list that will fully take off the burden of the differentials and clinical decision making off our minds removing stress and give physicians the time to incorporate communication skills and establish rapport with their patients.

How did we at OSCEhome formulated the OSCEhome Systematic Approach ?

We started by preparing a list of all signs and symptoms a physician faces. We wrote one sign or symptom on a separate sheet of paper. Then for each symptom or sign we wrote all the possible differentials. Then, we draw a table, assigned a column for each differential and wrote that symptom/sign presentation details, quality, duration, relation to other symptoms/signs, and red flags.. Etc.. Then for every detail, we wrote questions to ask for or points to examine.

Obviously, there are now, many identical questions or points to examine concerning this symptom among all these differential diseases. We started to merge the diseases’ columns into one set of questions. When the same question is required for several diseases, we placed these diseases’ names between brackets after the question to help us later with the clinical decision making process. Then we arranged these questions and points to examine in a logical easy flowing flowchart.

We have noticed that there are some details that are not required if you are just screening for a symptom and not thoroughly gathering details about it. So, we divided the to ask/do list into two files, we placed the must ask/do important ones up in the list for screening, and the rest at the bottom for detailed data gathering sub-file, and just in case we run out of time.

What about communication skills? It a major issue to ensure an easygoing interview professional organized interview and to achieve a mutual understanding and respect. We rephrased the questions to meet communication skills guidelines. e.g. English language issues, open ended questions, non-leading questions, respective manner ..etc.

Now, we have all the needed questions to ask and points to examine concerning that symptom on a separate sheet of paper. We placed the sheet in a separate file, labelled it with the symptom/sign name. Then, we repeated the same process for all other signs and symptoms.  Again, there are now, many identical questions or points to examine among all these symptom/signs.

We started to gather identical questions or points to examine into a separate file box and crossed it out on that symptom/ sign sheet. e.g questions about medications, past illnesses, social, ..etc.

Now, we have three sets of box files;

  1. Chief complaint data gathering box file,

  2. Specific symptom/sign box files, and

  3. Standard questions box file.

Remember, in real practice, as well as during OSCE stations, our time is limited. So, we carefully went into each of these box files and rearranged the questions and points to examine for maximum time efficiency.

We came up with a tree of a step by step history taking and physical file boxes. During the patient interview, you go through the file boxes one by one. You only open the box files you need.

 

 

Let us take an example. A patient presented with cough.

  1. Introductions box: 5 sentences to say.

  2. Chief Complaint: 10 question to ask.

  3. HPI: 15 questions to ask.

  4. Respiratory question box: 10 questions to ask.

  5. Standard questions box: 14 questions to ask.

  6. Wrap up box: Sentences for 8 points to explain.

DONE!

Most of the patients’ answers will be “NO”. How long then, will it take you to ask all these questions and wrap up the case?

FIVE minutes! And you have COVERED all the guidelines and checklists.

We created similar flowcharts for the physical examination, counselling, and ER stations that, with practice, will take you just 5 minutes to perform.

ONE flow chart of 7 steps with 23 history taking and 24 physical examinations boxes to choose one depending on the case !

 

Rest assured that all the guidelines are fulfilled, including communication skills.

You won’t forget anything to ask, examine, or explain. No need to be anxious and nervous.

You will be on a relaxed autopilot mode! Letting you focus on the clinical decision process and communication skills.

The systematic approach took three of us a full year to finalize and nine years so far to tweak.

Don’t you agree, it is worth a try? It is yours in just few minutes for the cost of a cup of coffee a day for a month!

 

Protect yourself, save your time and effort and get your OSCEhome ebook package now at:

 
http://www.oscehome.com/#A_Step_By_Step_Guide_To_Mastering_The_OSCEs_

     
     Have a nice day.

     Al

     http://www.oscehome.com/#A_Step_By_Step_Guide_To_Mastering_The_OSCEs_