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Prepare

Review the patient's chartand other data

Assess and prepare thephysical environment

Optimize comfort andprivacy

Minimize interruptionsand distractions

Assess ones own personalissues, values, biases, andassumptions going intothe encounter.

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Open

Greet and Welcome the patientand family member present

Introduce yourself

Explain role and orient patient to

the flow of the visit Indicate time available and other

constraints

Identify and minimize barriers tocommunication

Adjust your language and

vocabulary to that of the patient Accommodate patient comfort

and privacy

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Gather Information

Survey Patient's Reason for theVisit Start with open-ended questions

Invite patient to tell the storychronologically ("Why don't youstart from the beginning of your

illness") Allow the patient to talk with

minimal interruptions.

Actively listen Encouragecompletion of the statement of allof patient's concerns throughverbal and nonverbal

encouragement ( "tell me more","anything else?", lean forward )

Summarize what you heard. Checkfor understanding. Invite more("Anything more?")

Determine the Patient's ChiefConcern Ask close-ended questions that are

non-leading and one at a time

Define the concern completely

Complete the Patient's MedicalDatabase Obtain past medical and family

history

Elicit pertinent psychosocial data

Summarize what you heard andhow you understand it, check foraccuracy

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Elicitand Understand Patient's

Perspective Ask the patient's idea about

illness or problem

Ask what patient'sexpectations for the visit are

Explore beliefs, concerns andexpectations

Ask about family, community,and religious or spiritualbeliefs and values

Acknowledge and respond to

patient's concerns, and nonverbal cues

Acknowledge frustrations /challenges / progress (waittime, uncertainty)

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Communicate During the Physical

Exam or Procedure

Prepare patient

Comment on aspectsand findings of the

physical exam orprocedure as it isperformed

Listen for previously

unexpressed data aboutthe patient's illness orconcerns

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Patient's Education - Share

Information Use Ask-Tell-Ask approach to

giving information meaningfully -Ask about knowledge, feelings,emotions, reactions, beliefs andexpectation - Tell the informationclearly and concisely, in smallchunks, avoid "doctor babble

Use language patient canunderstand

User relevant information toenhance understanding

Use aids to enhance

understanding (diagrams, models,printed material, communityresources)

Encourage questions

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Negotiate and Agree on Plan

Encourage shared decisionmaking to the extend thepatient desires

Survey problems and delineateoptions

Elicit patient's understanding,concerns, and preferences

Arrive at mutually acceptablesolution

Check patient's willingness

and ability to follow the plan Identify and enlist resources

and supports

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Close

Signal closure

Inquire about any otherissues or concerns

Allow opportunity for finaldisclosures

Summarize and verifyassessment and plan

Clarify future expectations

Assure plan for unexpectedoutcome and follow up

Thank patient - appropriateparting statement

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