Usmle Step 2 Cs - Difficult Patients

Usmle Step 2 Cs - Difficult Patients anxious patient Correct Answer: encourage patient to talk about his feelings ask about things causing anxiety give reasonable assurance "any pt in your situation may react th ...

Usmle Step 2 Cs - Difficult Patients anxious patient Correct Answer: encourage patient to talk about his feelings ask about things causing anxiety give reasonable assurance "any pt in your situation may react this way, but i want you to know that I will do my best to address your concerns" angry patient Correct Answer: stay calm don't be scared ask about reason for the anger give reasonable answers "I can understand why anyone in your situation might become angry under the same circumstances, but I'm here now and it is your time." crying patient Correct Answer: allow patient to express feelings wait in silence for him to finish offer a tissue show empathy place hand on shoulder "i know you feel sad, would you like to tell me about it?" patient in pain Correct Answer: show compassion offer help don't repeat painful maneuvers if patient does not allow to touch --> explain you need to perform maneuver and give reassurance "I know you are in pain, is there anything i can do for you to help you feel more comfortable?" "I know that you are in pain, and I want to help you. I need to examine you, though, to be able to locate the source of your pain and give you the right treatment." patient who can't pay Correct Answer: reassure the patient that you will provide care anyway offer referal to a social worker "Not having enough money doesnt mean you can get treatment. We can refer you to a social worker who can help you find resources." patient who refuses to answer Correct Answer: explain why it is important if patient still refuses, skip maneuver or question and document it on PN hard of hearing patient Correct Answer: face patient directly to allow him to read lips speak slowly use gestures if hearing loss is unilateral, sit closer to hearing side patient doesn't know medications or I don't recognize medications Correct Answer: ask if patient has prescription or a written list; if they don't ask if they can fax it to the office later phone encounter Correct Answer: press speaker button to call the patient no physical exam needed, so leave blank on PN how to handle challenging questions Correct Answer: be honest and diplomatic restate the issue in different words don't give a final diagnosis don't give false reassurance if answer is not known, say so pt who needs emergency surgery: "I can't afford the cost of staying in the hospital. I have no insurance. Just give me something to relieve the pain, and I will leave." Correct Answer: "I know that you are concerned about medical costs, but your life will be in danger if you don't have surgery. Let our social workers help you with the cost issues." "Should I tell my sexual partner about my venereal disease?" Correct Answer: "Yes. There is a chance that you have already transmitted the disease to your partner, or he/she may be the source of your infection. The important step is to have you both evaluated and appropriately treated." An anxious patient who you suspect has been abused asks, "Why are you asking me these questions?" Correct Answer: "I am primarily concerned about your safety, and my goal is to make sure that you are in a safe environment and that you are not a victim of abuse." A patient recently diagnosed with HIV asks, "Do I have to tell my wife?" Correct Answer: "I know that it's difficult, but doing so will allow you and your wife to take the appropriate precautions to treat and prevent the transmission of the disease." a doorway information sheet indicates that the pt is Mr. Smith and that he presents with dixzziness, but when you enter the room, you find a female pt Correct Answer: begin by saying "excuse me Mrs. Smith?" when the pt responds "No, I'm Mrs. Black." you say "oh, I think the nurse must have given me the wring chart. Hello, Mrs. Black. What brings you in today." remember..you must retake the vital signs, the ones on the original chart are of a different pt A pt attempts to seduce you "Doctor, do you have time to have dinner with me at my place?" Correct Answer: I am sorry, but that would not be permissible in the context of a doctor-patient relationship An elderly patient says, "I think that it is normal at my age to have this problem" (impotence), or "I am just getting old." Correct Answer: "Age may play a role in the change you are experiencing in your sexual function, but your problem may have other causes that we should rule out, such as certain diseases (hypertension, diabetes) or certain medications. We also have medications that may improve your sexual function." "I prefer treating it with more holistic remedies, like herbal medicines." Correct Answer: "Herbal medicines have been suggested for many diseases. However, their safety and effi cacy may not always be clear-cut. Let me know the name of the herbal medicine and I will check into its potential treatment role for this disease." "I am afraid of surgery." Correct Answer: "I understand your feelings. It is normal and very common to have these feelings before surgery. Is there anything specific that you are concerned about?" A patient who has a serious problem (unstable angina, colon cancer) asks, "I want to go on a trip with my wife. Can we do the tests after I come back?" Correct Answer: "I know that you don't want to put off your trip, but you may have a serious problem that may benefit from early diagnosis and management." "I did not understand your question, doctor. Could you repeat it, please?" Correct Answer: Repeat the question again slowly. If the patient still doesn't comprehend the question, ask if there is any specific word he didn't understand and try to explain it or use a simpler one. "What is a bronchoscopy?" (MRI, CT, x-ray, colonoscopy) what is an MRI? Correct Answer: Explain the meaning using simple words. For example, "Bronchoscopy is using a thin tube connected to a camera to look into your respiratory airways and parts of your lungs," or "An MRI is a machine that uses a big magnet to obtain detailed pictures of your brain or body." "What do you mean by 'workup'?" "It means all the tests that we are going to do to help us make the final diagnosis." Correct Answer: A patient who is late in seeking medical advice asks, "Do you think it is too late for recovery?" "I am glad that you came for help. We will do our best and hope for the best." A pt who is late in seeking medical advice asks "do you think it is too late for recovery? Correct Answer: It is never to late to seek help, and I am glad you made the decision to pursue treatment options with me. We will do our best to help you, but next time, I want you to feel comfortable coming to me as soon as you have feel you might have a problem. A patient with pleuritic chest pain asks, "Is this a heart attack? Am I going to die?" Correct Answer: "Given your current presentation, my suspicion for a heart attack is low. It is more likely that inflammation of the membranes surrounding your lungs is causing your pain, and this is usually not a life-threatening condition. However, we still need to do some