the einstein geriatrics fellowship core curriculum
TRANSCRIPT
The Einstein Geriatrics Fellowship Core Curriculum
The Einstein Geriatrics Fellowship Core Curriculum
•A 20 part lecture series designed for first
year geriatrics fellows
•Covers the ACGME content areas for
fellowship training
Communication and Interviewing Skills with the Geriatric Patient
Debra Greenberg, PhD
Objectives
• To review goals in interviewing older persons and their caregivers
• To review interviewing skills that will facilitate interactions with an older adult
Introductions
• How do you introduce self?
• How do you address the older adult?
Conditions for the Geriatric Interview
• Privacy
• Environment of the room
• Ability to see and hear provider
• Compensation for patients’ disabilities
Modification for the Hearing Impaired Person
• Use slow, clear speech • Allow adequate time for the patient to
respond• Assure adequate lighting to allow for
simultaneous lip reading• Maintain visual contact "face-to-face" to
allow for lip reading• High-pitched voices should be deepened
Most hearing loss is high frequency
Modifications in Interviewing With an Interpreter
• Interpreter vs. Translator
• Interpreter should be non- family members whenever possible
• The patient's permission should be obtained prior to using a family member/friend as a translator
Modification in Interviewing People with Dementia
• Families and significant others should be interviewed separately whenever possible
• When possible older person’s permission should be obtained prior to separate interviews
Geriatric Social History
• Is there social support?
Geriatric Social History
• Personal History
• Place of origin
• Level of education
• Marital status and history
• Children/grandchildren and their health
• Religious background
• Habits: Alcohol, Cigarettes, Exercise
Geriatric Social HistoryInformal Support
• Who do they live with? • Contact with family and friends
Type/frequency of interaction -who visits?• Activities/hobbies - where do they go?• Significant losses: function abilities,
lifestyle, significant others • Plans for the future
Geriatric Social HistoryFormal Support
• Current Financial Status
• Insurance
• Formal Supports – eg. home care agency
• Involved Agencies
“The 3Ps”
• Presenting issue
• Precipitating issue
• Perpetuating issue
Determine the Purpose of theContact
• Presenting Issue
• Why is the person here? What do they want?
Routine health care
New problem/new provider
• A problem for the patient/ caregiver
Purpose of theContact
Precipitating Issues
• What is their previous experience with health care? With other MD’s?
• How have they negotiated the health care system in the past?
Purpose of theContact
• Perpetuating issues
• What makes health practices and attitudes hard to change?
• What do we want?
Style of Inquiry
• Repeat or rephrase
• Observe themes
Shifts in topics, evasiveness
• Follow-up on inconsistencies
• Tolerate silence
Style of inquiry
• Questions
Open ended – “Who do you live with?”
Multiple choices - “ Which of these do you want to focus on today?”
Closed ended – “How many drinks do you have a day?”
Style of Inquiry
• Listening
• Observing - hidden or unspoken clues
• Interrupting
• Using silence
• Double tasking, documenting while talking or listening ?
Challenges
• Conflict
• Losing one’s temper
• Dual interview
• Door knob problems
What do our Patients Want?
• To establish and maintain relationships with medical staff
• To maintain a sense of control over their bodies and lives
• To involve important people in their lives in their health care or to defer to others or to maintain privacy and independence from others
• To have their needs and fears heard• To have information about their health including
prognosis, as requested
Is there a Joint Treatment Plan?
Resources and Limitations in Planning • Impact of past or present roles, education,
employment, and values, health care beliefs• Relationships and current support systems• Reaction coping style• Resources financial, insurance, short and
long term plans
Reflection and Review of the Interview
• Form an impression from verbal and non-verbal clues of patient’s health care goals
• Were the patient’s needs understood?• Were you understood?• Was the reason for the visit completed? • Left open? Further negotiation needed
with the patient?
What is a good patient interaction?
• Balance the need for a good quality of care and a good quality of life
• Determine patient preference, diagnosis and treatment options
• Engage in joint treatment plan• Accomplish with empathy for the
challenges of aging and our common humanity