शैडोइंग अभ्यास: Communication Skills: A Patient-Centered Approach - YouTube के साथ अंग्रेजी बोलना सीखें

Come in.

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Come in.

Miss Bellamy?

Yes.

Hi, I'm Connie Harris.

I'll be your doctor today.

Let me just wash my hands really quick.

Would you prefer Miss Bellamy or could I call you Pat?

Pat's fine.

Great.

Well, it's nice to meet you.

Nice to meet you.

Can you tell me why you're here today?

I have a terrible headache.

That looks really bad.

Yeah, it does.

Is there anything else besides your headache that you want to address here today at the clinical program?

No, it's just that, except I am concerned.

I just recently changed insurance companies and I'm not sure this is going to be covered yet.

Alright.

Was there anything, because what we can do is while we're talking and I'm doing your history and physical,

I will have my office secretary look into the insurance plan that you have.

So you don't have to worry about that.

Yeah, that sounds good.

Okay, sounds great.

Is there anything else?

No, I just, this is just really bad.

Okay.

So what I'd like to do today,

and let's take a look at what's causing your headache.

I will go over history,

physical, and then we'll do again a physical exam,

and then we will look into your insurance policy and make sure that's all taken care of.

Does that sound like a good plan for you?

Yeah, that's good.

Perfect.

So tell me a little bit more about this,

the head pain that you're having.

Well, it started about three days ago and nothing has helped it.

It's just laid me flat.

I haven't been able to go to work.

Nothing's helped.

It's all over.

It's really bad when I move,

so I'm trying not to move too much.

And the light is bothering me a lot.

Okay.

And unfortunately I can't dim the lights in this room,

but I'll try to go quickly and it would be okay if I took some notes.

Oh sure.

Alright.

So you said this headache started about three days ago?

Yeah.

Okay.

Was there anything that brought it on,

anything unusual that happened maybe three days ago?

Not really, no. Okay.

Can you tell me anything that makes it better?

Oh nothing's made it better.

I took some Tylenol, I tried Motrin, nothing.

I just try not to move too much.

Alright.

Is there anything that makes it worse?

Yeah.

Movement.

And light.

Okay.

And it's just constant though.

There's, you know, it doesn't, it's just constant.

It's all over.

Okay.

So if you had to rate it on a pain scale,

zero being no pain, ten being the worst pain you ever had.

A tan.

I've never had a headache like this.

Okay.

Yeah, that sounds really bad.

Now, as far as radiation, does it move?

You said the pain is all up here in the front of your head.

It's kind of all over.

But also, I've got this shooting pain down my neck,

and my neck is very stiff.

Okay.

But it's the entire head.

Entire head, okay.

As far as in the timing,

you said that it started three days ago,

but you said is it constant?

Yeah, it started gradually, but once it got there, it hasn't gone away.

It doesn't get better, it doesn't get worse, it's just the same.

So do you, what I want to get is your perception of what you think is going on.

Oh, I don't know.

I just, I can hardly think.

It's so painful.

I just, because it's so bad, I was afraid.

My neighbor had a headache and ignored it last year

and he suddenly started having seizures and it turns out he had a brain tumor.

So I thought I just should come in and look at it.

Yeah, I can understand your concern.

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How is it impacting your daily life?

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I can't go to work.

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I can't do anything.

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Yeah.

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Okay.

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So it sounds like it's really impacting your life.

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Yeah, I can't.

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Okay.

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If it's okay, I would like to go talk a little bit about your medical history and your social history.

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Okay, sure.

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All right.

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history, do you have any medical conditions I should be aware of?

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I was diagnosed with high blood pressure about three years ago,

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but we've been addressing it with diet changes.

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Okay, so it's controlled with diet?

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Yeah, I go in yearly,

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I had been, and it's been well controlled,

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so I haven't been on medication.

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No offense for that.

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But other than that, I haven't had any problems.

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Okay, any surgical history?

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No. Any hospitalizations?

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No. All right.

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And you said the only medicine you're taking was the Tylenol Maltrand.

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Yeah, and they didn't help.

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Okay, you just wanted to verify.

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Do you have any drug allergies?

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No. Okay.

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What about family history?

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Do you have any medical history of headaches or?

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In my family?

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Right.

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You know, my mom said she used to get migraines when she was in her 20s and 30s.

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Okay.

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But I don't remember her saying anything else about it.

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My sister, I have one sister, she's healthy.

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My dad, he has high blood pressure.

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Other than that, he's healthy.

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And that's about it.

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I don't have any kids.

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All right.

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It's all right, I would like to ask you some social history questions that,

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just for, there are records.

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Do you smoke?

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Yeah, I do.

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Is it cigarettes or chewing gum?

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Yeah, cigarettes.

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And how much do you smoke?

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About a half a pack a day.

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What about alcohol?

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I don't drink.

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Also, are you married?

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Yeah, I'm married.

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And children?

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No. And just some additional questions is looking at your kind of GYN history,

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are you last menstrual period?

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Oh, I'm in menopause.

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Okay.

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Yeah.

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So, going back into the history again,

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have you, you said your mom had migraines earlier on.

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Have you been around and no other,

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you haven't been nauseous or have you been in other sickness?

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Yeah, I've been nauseous.

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Okay.

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In fact, I threw up twice early on because when I move it makes me nauseous.

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Okay.

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Nothing out of the ordinary over the past couple of weeks?

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Have you been on any trips or anything?

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Actually, a week ago I was in North Carolina for a family reunion and there was a four-year-old who was sick there.

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I don't know what they had but I guess they ended up taking him into emergency.

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So let me just summarize to make sure I've got everything straight

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so far is you started at an onset of a severe headache about three days ago.

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It's worse with movement.

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Light really makes it hurt bad.

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It's a 10 out of 10 pain and you're also complaining of a stiff neck with that.

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It came on gradually and it's been constant pain in the frontal area.

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Medical history, you're in hyper you have high blood pressure

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but that's controlled with diet no surgical history no really hospitalizations the pain though isn't really impacting your day-to-day living

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and daily life you try to tell no motor

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and it didn't help otherwise no medications you've got the family

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history of your mom with migraines otherwise your family is healthy you smoke about a half a pack a day,

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you don't drink, and then you were,

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you said you took a trip about a week ago,

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or two weeks ago?

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Yeah.

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Okay.

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It was a family reunion a week ago.

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Yeah, I don't know.

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It was in North Carolina.

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All right.

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Yeah, I can understand your concern about your friend.

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You said that he was having seizures.

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I've just never had this kind of pain before.

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Yeah, and I can understand that.

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So what I would like to do is,

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we've pretty much gone over the history.

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What I'd like to do is complete a physical exam,

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do some testing,

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and I want to ask too if there's any other concerns I need to address before we get to that final exam.

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Okay, that sounds good.

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Okay, sounds great.

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Okay.

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All right.

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Hi, I'm Deb.

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I'm your standardized patient.

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Nice job.

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I'm going to give you some feedback on your communication skills in this encounter,

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but before I do, how did you feel it went?

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Pretty good.

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I was nervous at first,

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I think, and just trying to make sure

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that I was getting all patient information so we could make sure we got the correct tests.

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Yeah, yeah.

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How did you feel when you walked in?

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You feel pretty comfortable?

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I think I got more comfortable as we sat down and got to talking.

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I could see that.

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Yeah, good.

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Okay.

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Well, I thought you did a nice job.

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You had an appropriate introduction,

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introduced yourself for some last name, shook hands.

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I think you have a very warm demeanor and you're comfortable,

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which makes me as a patient comfortable.

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You did elicit my chief complaint and asked about any other concerns,

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and that's when I told you I was also concerned about my insurance,

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so that was another thing on the agenda.

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So you did set a mutual agenda,

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asked me if I agreed,

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and so we had a clear roadmap going forward,

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so you did, you hit all those real well.

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Your first question, tell me about this pain,

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that was a nice open-ended question,

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so it allowed me to then tell my story,

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followed up with some more pointed questions just for clarification.

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and you're an active listener,

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had good eye contact, and could do a little bit more reflective listening,

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just little points where you could verify,

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check for accuracy, maybe paraphrase as I'm going through.

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You did a nice summary in the middle.

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That's good.

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But just a little bit more reflection to let me know as a patient that you're hearing me.

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You asked my perspective of what I thought was going on

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and then you got the story of my fear that maybe I've got a brain tumor,

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I don't know.

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Right, right.

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Yeah.

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So I thought you had nice flow, logical sequence of questioning.

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A little bit of signposting,

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we just covered this and now we're going to do that.

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I heard that once.

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As these interviews get longer,

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you're going to want to signpost between each section.

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I've taken your history, now I'd like to go into a physical exam.

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Did a nice summary in the middle.

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You moved through quickly, so you attended to the timeline.

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You did ask permission to ask some social questions.

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Maybe you want to mention,

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social questions may not be a flag for me that this could be personal or uncomfortable.

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Oh, right.

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Maybe I'm going to ask a little more, some personal questions here.

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Is that all right with you?

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Just so I'm, social questions sounds fine to me until you start asking something that might sound personal.

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So you might use the word,

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some more personal questions here.

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judgmental, didn't bat an eye when I said I smoke half a pack.

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You have nice vocal range,

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eye contact, comfortable demeanor, so that felt real good.

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And then you did a summary at the end and asked,

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did you ask, do anything else?

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Okay, so anything else before we do a physical exam.

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So it was very nice, nice encounter.

273

Well, thank you so much.

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Nice meeting you.

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You too.

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