Post 1 Patient consultations have traditionally been a preserve of physicians an
Patient consultations have traditionally been a preserve of physicians and physician assistants. However, with the expanded scope of practice of non-medical practitioners, such as advanced practice nurses, the clinical interview has become a critical skill in advanced assessments done by nurse practitioners (Diamond-Fox, 2021). Assessing a patient’s medical history forms the basis of health interventions, including obtaining health needs, allergies, social determinants for health, genetic predispositions, and patient and community resources available to fund interventions. For this discussion, I was assigned an 80-year-old white male with angina living on a rural farm 80 miles from the nearest healthcare center. These details assist the healthcare practitioner in tailoring the interview to the patient and may provide ice-breakers to begin the interview.
The interview should ordinarily occur in a private, secure, and relaxed environment to enhance patient comfort and prevent distractions. The process begins with the provider’s introduction and expressing a willingness to help the patient. This opening helps to create rapport and lay the ground for a therapeutic relationship. At the same time, the provider cultivates trust and confidence to facilitate the collection of a thorough history from a relaxed patient. As the interview progresses, the provider keeps communicating clearly, avoiding technical terms, and requests to use an interpreter if required (Diamond-Fox, 2021).
A risk assessment I would conduct on my allocated patients is a frailty assessment. A frailty assessment is indicated in advanced age and chronic diseases to confirm physiologic reserve and ability to adapt to health stressors (Boreskie et al., 2022). Frail individuals are prone to adverse health outcomes, such as dependence, falls, hospitalizations, and mortalities. A common tool used in frailty assessments in ambulatory settings is the Fried physical frailty phenotype test (Boreskie et al., 2022).
What is the reason for your visit today?
Do you have or are you aware of any other health issues in the past?
Are there cultural, ethnic, or spiritual practices incompatible with the care we provide you?
Are you taking any alternative or complementary medicines, including over-the-counter herbal medicines?
Do you have any concerns arising from the place you are living currently?
Case: 21 year old Filipino college student living in a dorm wanting to know what birth control is.
Summary of Interview and Techniques
The interview techniques for this patient would start by assessing for a need for a translator since the patient is foreign. Studies have shown that language barriers are a leading cause of miscommunication and poor delivery of healthcare to patients (Al Shamsi et al., 2019). If one is needed, one should not use any family members or friends in the room, only professional translator systems to ensure the patient is understood and is speaking for themselves (Ball et al., 2019). Then, I would start by assessing any prior knowledge about birth control methods and gain a sexual health / gynecologic history. When asking these questions, it is important to remain non-judgmental and open to any questions or concerns, as this may be a sensitive topic that the patient is already nervous or embarrassed to talk about. It is important to give the patient time to speak and express all concerns and goals of treatment (Ball et al., 2019). If she has no prior knowledge about birth control options, it is also important to try not to overwhelm the patient with too much information at once. Pamphlets that the patient can take home and read on her own later can be very helpful, as well as reassuring the patient that she can take her time in choosing the best option for her, and to take time weighing out the pros and cons of each option. Most importantly, in regards to birth control, one of the first concerns would be to know if she has a family history of breast cancer or blood clotting disorders. If any of these are present, hormonal birth control would not be the best option, and non-hormonal options such as the copper IUD might be better. It is also important to stress the fact that contraceptives do not prevent STI’s, and further education and pamphlets on prevention of STI’s should be given. If the patient expresses concerns about cost and healthcare access since she is a college student, it is important to know your local resources such as Planned Parenthood or local clinics that provide services for little cost. Educating on the importance of routine tests such as PAP smears, STI testing, pregnancy testing, HPV vaccination, and follow up visits is also imperative. At the end of the interview, after answering any further questions, I would address the patients understanding of the information by asking her to briefly review the key points of the education I provided, as well as asking her to tell me her next steps to prepare for the follow-up visit. I would also ensure all education materials and pamphlets are handed to the patient to take home for review. If the patient has any complicated illnesses or gynecologic issues, referring the patient to a gynecologist may also be warranted.
The initial interview and all follow-up visits should routinely reassess sexual concerns, relationships, current prevention methods, as well as routine testing and treatment of STI’s (American College of Obstetricians and Gynecologists, 2019). Furthermore, when obtaining an initial health history with any patient, it is important to review and document a current medication list, and obtain a thorough family history, social history, and a cultural and religious history (Sullivan, 2019). It is always important to remain unbiased and respect the patients cultural and religious beliefs, especially in this instance with sensitive subjects such as sexual relations.
Risk Assessment Tool
One of the risk assessment tools that can be used to obtain a sexual history from this patient is the Five P’s of Sexual History (Ball et al., 2019). The five P’s stand for: 1.) Partners; 2.) Practices; 3.) Protection from STI’s; 4.) Past history of STI’s; 5.) Prevention of pregnancy (Ball et al., 2019).
Five Targeted Questions
Based on the risk assessment tool used above, five targeted questions may include:
Are you currently sexually active, and if so, with multiple partners?
What is your current knowledge about birth control methods and safe sex practices?
What is your current understanding of sexually transmitted infections and ways to prevent them?
Have you ever had any sexually transmitted infections?
What is your current understanding of ways to prevent pregnancy?