Patient Interview

Integrated Pharmacy Practice Lab

#1
4TH Pharm D
Pharmacy Practice Dep.,
Unizah College Of Pharmacy
2015-2016

Communication skills
Active listening
Empathy
Building rapport
Open-ended questions
Close-ended question
Leading questions
Silence
why
Non verbal communications cues

Active listening
It is a dynamic process that include both
hearing what is being said as well as
interpreting the complete words that are
spoken to understood the message that is
being delivered.
You have to be concious enough to the
patient to give the patient attention and
concentration away of external and internal
distractions and interuptions

Empathy
Is defined as intellectual identification with
feelings, thoughts and attitudes of another.
Empathy ways depends on the particular
patient and situations.
For example, nodding head, making a
statement, or asking a follow up questions.
Dont say I know what you are feeling
But how are you feeling

Building rapport

It sets the tone of the interview and allow the patient to

feel comfortable with you, there by making the lines of
communication more open and honest.

hello Mrs., my name is Nouf. I am a clinical

pharmacist I am a part of your medical team, and
I am here to ask you a few questions about what
brought you to the hospital and discuss the
medications that you have been taking at home.

I have a few questions for you , Mrs. Amal. Is it

okay for me to speak to you with your
family/friends in the room or would you prefer to
be alone while we talk?

Open And Closed Ended

Question

Open-ended
?
Require the quis.
patient
to

Close-ended quis?

answer with more than

a simple yes or no in as Play a role in
communicationg with
exploring symptoms
patient to collect data
What symptoms are you
experiencing?
Did you take your blood
pressure medication this
How you are feeling
morning?
today ?
Are you feeling well
How are you taking your
today?
medication?
Do you take your
medication as directed by
the physician?

What is the question to be

avoided during an interview?
Leading

questions:

To obtain an accurate response to your

questions, leading questions should be avoided.

why
Why may get the patient may feel the need to
defend his or herself but what he may thought
that you may offer judgment
Why do you miss your doses?
What causes you to miss your doses?

Lock & Comment

Silence
Silence in interacting with your patient is
more significant than you may realize.
Length of silence is definitely an art.
Long enough but not so long to get the
patient feeling uncomfortable

Non vebal communication

Tone of voice
Choice of language
Facial expressions
Body posture and position
Gestures/movements
Eye contact

PHYSICAL EXAMINATION
It Is The Role Of Medical Student, Resident,
Physician
Height
Weight
Vital Signs
Inspection & OBSERVATION

MEDICATION HISTORY
It will help you to identify, prevent, and or resolve any
active or potential drug-related problems.
We have to obtain accurate MH.
Why?
1. Ruling in or out a drug-related adverse effect
2. Preventing drug-drug, food-drug, drug-disease
interactions.
3. Monitoring for clinical signs that may be masked due
to a drug.
4. Evaluating laboratory finding, as certain drug may
affect the results.
5. Preventing prescriping errors

MEDICATION HISTORY
(cont.)
It verify correct OTC or herbal agents
selection and administration.
It gives you the opportunity to assess for
any drug-drug or drug-disease interaction
that may occur due to OTC or herbal agents.
gives you the opportunity to councel and
educate about OTC medications and herbal
agents.

Medication History Components

Medication name
Strength and dose
Frequency
Timing
Indication
Adverse reactions
Past medication history
Medication history
Adherence
allergies

Close the interview

It have to include:
Assessing the patients understanding
Providing an opportunity for the patients to ask you questions.
Discussing any follow up plan

You may use the teach-back methods

Thank you for all the information you have give me. I will be
sure to document this in your medical record. Before you go I
just want to make sure that we discussed how to take your
medication properly. Would you mind showing me how will
you use your inhaler when you grt home?
What question do you have for me?
Well, it was great meeting you, please call the pharmacy if
you have any question. Our number is on you label.

Close the interview

doctor will use various techniques to assess

the symptom:Anemia. These will include a
physical examination and possibly diagnostic
tests. (Note: A physical exam is always done,
diagnostic tests may or may not be
performed depending on the suspected
condition) Your doctor will ask several
questions when assessing your condition. It is
important to openly share any pertinent
information to help your doctor make an
accurate diagnosis.

Dietary historyWhy:e.g. including

vegetarianism, lack of red meat, animal
products and green leafy vegetables - may
indicate dietary deficiency of iron , folate or
B12 as cause of anemia.

Are you pregnant?Why:pregnancy causes

increased physiological requirements of iron
and folate.

Alcohol history?Why:Alcohol can cause

anemia by several mechanisms e.g.
Gastrointestinal blood loss due to
oesophageal varices, peptic ulcer; folate
deficiency and sideroblastic anemia.

Past medical historyWhy:Chronic disease

can cause anemia e.g. connective tissue
disease, malignancy , thyroid disorders ,
Addison's disease.

Surgical historyWhy:e.g. previous stomach

or small bowel surgery can cause Vitamin
B12 deficiency; any recent surgery can
cause blood loss.

Have you experienced any

shortness of breath,palpitations,chest pain
,fatigue/tiredness, orheadache?
Why:These can all be symptoms of
anemia.

Have you recently had any ringing in your

ears (tinnitus), decreased appetite and
weight loss (anorexia),abdominal pain$,
indigestion, or change in bowel habit?
Why:Whilst these may all appear to be
unrelated to anemia, they can be
experienced as symptoms.

Have you experienced heavy or prolonged

menstrual bleeding recently?Why:
Menorrhagiacan be a cause of
iron deficiency anemia.

Have you noticed any bowel changes

recently, particularly darker or more
offensive smelling stools?
Why:Gastrointestinal bleeding may cause
iron deficiency anemia, and may be
exhibited by some changes in your stool or
bowel habit.Bowel Cancercan also cause
iron deficiency anemia, and may cause
changes in your bowel habit as well.

Do you suffer from gastrointestinal reflux

disease orpeptic ulcer disease?Why:These
can cause you to experience chronic blood
loss and result iniron deficiency anemia.

Do you have hemorrhoids?

Why:These can cause you to lose
small amounts of blood on a regular
basis and can be the cause of
anal symptoms,anal swelling,
anal itch, andiron deficiency anemia.

To the best of your knowledge, have you

ever been diagnosed withdiverticulosis/
diverticulitis,inflammatory bowel disease
orcolitis?Why:These are all conditions
affecting the large bowel, which can result
in acute or chronic gastrointestinal blood
loss and thus causeiron deficiency anemia.

Have you ever lived or visited any areas in

the topics, and if so where/when?Why:
Hookwormcan be a cause of
gastrointestinal blood loss and
iron deficiency anemia, however it is much
more common in areas in the tropics.

Can you tell me a bit about your diet and

living conditions?Why:Poor diet and living
conditions can causeiron deficiency anemia
, however this is more likely to be the case
in children rather than adults. Additionally
certaindiets(e.g.vegans) may not
consume enough of certain vitamins, and
thus cause a type of anemia.

Are there any diseases which run in your

family, such asthalassemiaorcoeliac
disease?Why:There are many conditions
which can causemalabsorption(such as
coeliac disease) and thus cause
iron deficiency anemia.

Thalassemia is a genetic and inheritable

condition which results in the abnormal
formation of hemoglobin in your blood, and
may causeiron deficiency anemiain an
otherwise healthy person.

Does anyone in your family (even

generations ago) come from Mediterranean
areas, India, Africa or Southern Asia?
Why:There is an increased risk that you may
carry one or more genes for Thalassemia if
you have genetic family members who are
from those areas. Thalassemia can be a
cause ofiron deficiency
these can all be signs of
Plummer Vinson Syndrome.

Have you ever been diagnosed withanemia

before? If so, what has happened since?
Why:Anemia isn't an uncommon diagnosis, and
there is some likelihood that you may have been
diagnosed with it before. If you have, then it is
important for the Health Professional you are
currently seeing to know what has transpired
since that diagnosis. If you have made any
changes, then it is important to evaluate whether
or not they are having the desired effect. For
example, whether or not you changed your diet
or began taking iron supplements.

Have you had anyinfections?Why:Some infections

which last for a long time may cause a type of
anemia known asanemia of chronic disease.
Have you ever been diagnosed withRenal Failure?
Why:This is a condition which can last for a long
time and may causeanemia of chronic disease.
Have you experienced anyarthritis, or been
diagnosed withrheumatoid arthritis?
Why:Rheumatoid arthritis as well as some other
Rheumatological conditions can result in
anemia of chronic diseaseas they tend to be
experienced for some time.

Do you, or have you had cancer?

Why:Cancer and its treatment can have a
huge impact on your body, so much so that
its effects can result in
anemia of chronic disease.

Have you had any illnesses before,

particularly ones which have lasted for a
long time and which you might still have
now?Why:Chronic disease can have longterm effects on other aspects of your
health, such as the way in which your body
produces blood. These diseases can cause
anemia of chronic disease.

Do you drinkalcohol, and if so how much?

Why:Excessive consumption of alcohol for
a prolonged period of time can result in
some forms of anemia.
Do you have diabetes, or any liver or heart
disease?Why:These can all be caused by
some forms of anemia which are the result
of the abnormal production of hemoglobin
in your blood.

Have you recently experienced any

weight gain,lethargy,tiredness,
constipation,muscle aches(myalgia) or
been particularly avoided being cold?
Why:These can all be signs of
hypothyroidism, which may also be a cause
of anemia.

Is there any possibility that you might be

pregnant?Why:Pregnancy can be a cause
of anemia, and it is important to consider
and rule out this possibility in all women of
reproductive age.

If you arepregnant, have you experienced

anyheadache,chest pain,abdominal pain,
vomiting,shaking,visual disturbanceor
experiencedpre-eclampsia/
pregnancy induced hypertensionin any
previous pregnancies?Why:Preeclampsia is
a very serious condition which in addition to
the above listed symptoms, can cause a
type of anemia.

Do you or have you taken any medications?

Why:Some medications such as
azathioprine, phenytoin and trimethoprim
can cause some types of anemia.

Do you suffer fromdiabetes,thyroid disease

,Addison's diseaseor any
autoimmune diseases/disorders?
Why:Along withpernicious anemia, these
can all be associated with one another.
Having any one of these autoimmune
conditions increases your risk of having (or
being later diagnosed with) any other
disease in this group.

Have you had any surgery recently?

Why:Some surgeries such as a
gastrectomy/partial gastrectomy can result
in a form of anemia.
Have you noticed any changes or absence
in your sense of touch and feeling?Why:
Paresthesiacan be seen in anemia.

Have you recently thought that your skin or

eyes might be more yellow than usual?
Why:Jaundice can be noticed as a subtle
change in the colour of your eyes and skin,
and may be seen with anemia.

Have you noticed any changes or difficult

withvision?Why:Some eye problems such
as retinal hemorrhages can occur in some
types of anemia.

Have you noticed any changes in yourhair

recently?Why:A subtle but discernable
premature graying of your hair may occur
with some forms of anemia.
Have you had any fevers?Why:Fever can
be a sign of many difference disease
processes, but can be associated with a few
types of anemia.

Has anyone in your family ever been

diagnosed withsickle cell anemia, or do you
have any African heritage?Why:Sickle cell
anemia is a hereditary condition affecting
hemoglobin in blood which can result in
anemia, jaundice and episodes of pain in
your peripheries. It is more likely to be
carried and experienced by those with some
or any ethnically African heritage.

Do you know if anyone in your family has

ever been diagnosed with any blood
disorders or diseases?Why:Apart from the
few conditions specifically mentioned
above, there are many other inheritable
conditions which can affect your blood.
These may includeGlucose 6 Phosphate
Deficiency,Hereditary Spherocytosis, and
Pyruvate Kinase Deficiency.

Have you recently received any blood

transfusions or any blood products?
Why:Contrary to what generally happens
blood transfusions can sometimes cause
anemia. This may be because the
blood/blood product you received was
entirely compatible with you.

Do you have anyartificial heart valves, any

heart disease, or any recent heart
problems?Why:Some types of artificial
heart valves and some cardiac diseases can
cause anemia.

Have you ever been or traveled to

anywhere thatmalariais known to occur?
Why:Malaria can cause anemia. In general,
it is vitally important that you tell your
Health Professional about any recent or past
(up to many years in the past) travel or
holidays you have undertaken.

Have you noticed in your urine, particularly

at night?Why:Anemia can be sometimes
be caused by a condition which causes your
blood cells to break apart at night or at
times of infection or stress on your body (
paroxysmal nocturnal hemoglobinuria).
Have you noticed anyulcerson your legs?
Why:These can sometimes be associated
withsickle cell anemia.

Have you ever experienced your fingers go

white or red and painful?Why:An
occurrence calledRaynaud's Phenomenon
where the fingers/toes may go pale then
blue and then finally red. There is much
ache and pain associated with this serious
of changes, and the condition may be
associated with some types of autoimmune
anemia.

Have you noticed any changes in your

urine, or any purple spots
($purpura)/bruises on your skin?Why:
Acute renal failureand unusual bruising can
be seen along with anemia in thrombotic
thrombocytopenia purpura. There may also
be some neurological symptoms which may
resemblestroke/transient ischemic attack.

Anemia symptomsWhy:e.g. lethargic, tired,

shortness of breath, dizziness, chest pains,
palpitations - may indicate if symptomatic
or asymptomatic.
Menorrhagia?Why:i.e heavy periods with
clotting and flooding - may indicate cause of
chronic blood loss and thus anemia.

Peptic ulcer symptomsWhy:e.g. episodic

burning pain in upper abdomen below the
ribs related to meals - may be cause of
chronic blood loss and thus anemia.
Rectal bleeding?Why:may be due to
colorectal cancer or polyps, diverticular
disease, hemorrhoids , angiodysplasia and
thus be a cause of chronic blood loss and
thus anemia.

MelaeniaWhy:i.e black tarry stools indicates bleeding from the upper

gastrointestinal tract e.g peptic ulcer or
oesophageal varices and thus be cause of
anemia.
Coeliac disease symptomsWhy:e.g.
intolerance to wheat, bloating, indigestion,
diarrhea, bulky frothy stools - causes iron
and folate deficiency due to malabsorption.

Ulcerative colitis symptomsWhy:e.g. recurrent attacks of

loose stools, bloody diarrhea, mucous in stools - may be a
cause of chronic blood loss and thus anemia.
Neurological signs?Why:E.g. paresthesia, loss of vibratory
sensation, ataxia and mild dementia - may indicate
pernicious anemia.
Jaundice?Why:E.g. yellow skin and sclera, pale stools,
dark urine - may indicate Hemolytic anemia; if mild can be
due to pernicious anemia or due to chronic liver disease.
Symptoms of Chronic liver diseaseWhy:e.g. jaundice ,
easy bruising , itchy skin, enlargement of male breasts ,
loss of body hair , swelling of legs - may indicate cause of
folate deficiency and thus anemia.