Shadow Health Conversation Notes

A proper greeting:
1) uses a friendly tone
2) addresses both yourself and the patient by name
3) States your reason for being there
The narrowing and broadening of scope in a health history interview occurs in the contexts of:
an organized progression through topics related to patient health
How to structure a health interview
Greeting and identifying data
Chief Complaints
History of Present Illness (HPI)
Family History
Personal and Social History
Review of Systems
Greeting and Identifying Data
Greet patient and confirm patients name, age, and gender
Chief Complaint(s)
Identify symptoms or concerns causing patient to seek care
History of Present Illness (HPI)
Assess symptoms and patient’s thoughts and feelings about illness
Medical History
Determine allergies, presence and dates of childhood and adult illnesses, chronic health problems, immunization history, and past hospitalizations
Family History
Determine age and health, or age and cause of death, of parents, sibling, and grandparents, noting the presence of specific illnesses in family (e.g. hypertension, addiction, type II diabetes).
Personal and Social History
Evaluate education level, family and household dynamics, spiritual practices, personal interests, sleep habits, and lifestyle (e.g. tobacco, alcohol and illicit drug use, sexual history, exercise, and nutrition
Review of Systems
Assess the presence or absence of common symptoms related to each major body system.
To Shape patient interviews
Move from open questions to closed questions (shaped like a cone)
Open questions
“cast a wide net” – allow patients to communicate more generally, and allow them to emphasize their own concerns and priorities
Open question examples:
How did you injure your elbow?
What are your stomachaches like?
What prevented you from refilling your prescription?
How have you been managing your blood pressure
Key Open Question Words
“Describe”, “Tell me about”, “How”, “Why”
Open Question tips
– Ask the patient to elaborate or describe
– Convey empathy and avoid judgement
– Avoid unnecessary use of medical terminology or jargon
– Use concise language to convey a clear meaning.
Closed Questions
“zoom in” on particulars and refine their understanding of an aspect of patient health
Closed Question examples
– Has your pain gotten worse?
– Are your headaches focused on one side of your head?
– Has the medication helped with your heartburn?
– When did you start feeling fatigued?
Key Closed Question words:
“How many”, “How Often”, “Can you, do you, will you, are you”, “is it, has it, have you, etc”, “Which”, “Who”
Open or closed questions establish therapeutic rapport?
Closed. Good for:
– Sexual History
– Substance use
– Social or domestic problems
– Trauma
– Physical symptoms that the patient finds embarrasing
for Conversational Flow:
Move between open and closed questions.

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