chapter i overview of doctor-patient communication
section 1 background information and definition
1、when a patient tells a doctor his/her painfulness and other feelings, the doctor will surely understand the patient and be empathetic, or when a doctor explains his/her diagnostic and treatment opinions, and asks the patient to do what he/she says, the patient will surely understand and cooperate.
2、communication refers to any process in the exchange of information, ideas or feelings. it is conducted because people need to express their personalities and emotions.
3、as a lubricant between doctor and patient, communication is fundamental to a good doctor-patient relationship and a harmonious healthcare environment.
4、in a narrow sense, “doctor” as in the doctor-patient communication means medical staff in the medical institutions, and in a broad sense, it refers to not only medical practitioners, but medical facilities and their administrative staff, as well as medical educators.
5、during a healthcare or wellness service, communication between a doctor and a patient is led by the patient.
section 2 the role of doctor-patient communication
1、regarding that good doctor-patient communication improves doctor-patient relationship, the incorrect opinion below is a、communication helps develop mutual understanding between doctor and patient b、communication helps build emotional bond between doctor and patient c、communication helps satisfy the need for mutual respect between doctor and patient d、the description of the illness in communication is too detailed with too much jargon, making the patient and his/her family unable to understand
2、the main cause for medical disputes is a、miscommunication between doctor and patient b、miscommunication between doctor and patient c、citizen ethics d、the level of economic development
3、doctor-patient communication plays an important role in improving doctor-patient relationship and helping patients recover as soon as possible. it is important because of the following benefits: a、communication helps in the diagnostic and treatment process b、communication improves doctor-patient relationship c、communication increases the patients’ knowledge of diseases and makes them more cooperative d、communication helps prevent or address medical disputes
4、1.medical practitioners are responsible for curing patients and their diseases instead of helping and comforting patients.
section 3 principles of doctor-patient communication
1、which of the following is not one of the principles of doctor-patient communication? a、to put patients at the center b、to remain honest and credible c、to fully engage the patients d、to be empathetic with the patient
2、“the physical check-ups have cost me so much with the result that i’m perfectly healthy. it’s just not worth it.” what’s the proper approach in face of problems like this? a、the patient shall be asked to do the check-ups according to his/her indications, and kept informed. b、the doctor should make decisions according to the patient’s needs. c、the doctor should tell the patient limitations of every physical exam. d、it’s necessary to take account the patient’s financial conditions.
3、the patient’s physical condition and history of illness shall be kept confidential. this is an example of respecting the patient’s right of a、being informed and having their consent obtained b、individual privacy c、filing a complaint d、decision-making
4、the principle of informing patients and obtaining their consent implies that a、the patients shall be informed of the medical relationship b、the patients have the right to decide by themselves the medical treatment c、the patients shall fully comply with the medical treatment provided by medical staff d、on the basis of being informed, the patients have the right to decide the medical treatment by themselves
5、in the hippocratic oath, “i will… abstain from every voluntary act of mischief and corruption… further from the seduction of… freemen and slaves” refers to the principle of a、treating patients equally b、informing patients and obtaining their consent c、putting patients at the center d、fully engaging the patients
section 4 practical elements of doctor-patient communication
1、elements that medical staff should master to effectively communicate with patients include a、humanities quality and etiquette habits b、expression approaches and capability to get implications c、professional competence and plain language d、all the above
2、“doctors should not only have a pair of warm hands but a tender heart, as well as superior skills. doctors should put themselves in the patients’ shoes to feel what they feel, but also respect the laws of life.” according to this, what are the following elements that medical staff should master to effectively communicate with patients? a、humanities quality b、professional competence c、expression approaches d、life experience
3、medical staff should tell the patients who beat around the bush or obscure the problems straight out.
4、to patients and their families who behave in a self-centered, suspicious, rejecting or overcritical manner, medical staff should stay tolerant, open-minded and calm, and take the lead to establish a harmonious doctor-patient relationship that facilitates treatment
5、professional quality refers to a doctor’s medical knowledge and competence in diagnosis and treatment, and is the key element in doctor-patient communication.
chapter 2 medical history inquiry
section 1 definition and content of inquiry
1、as the song of 10 inquiries says, “first chills and fever second sweat, third head and limbs fourth defecation; fifth diet sixth chest and stomach, seventh hearing eighth thirst; ninth old illness tenth causes.” what skill used in ancient medical activity do you think the song reflects? a、look b、listen c、question d、feel the pulse
2、which of the statements about inquiry below is true? a、inquiry is a diagnostic method that a doctor takes medical history of a patient by inquiring the patient of relevant people systematically, conducts analysis and make clinical judgment. b、inquiry is the road sign and clue for disease diagnosis as some diseases can be diagnosed through inquiry. c、inquiry is the key moment to establish a harmonious doctor-patient relations. successful inquiry makes patients feel that a doctor is amicable, facilitates the doctor-patient cooperation and leads to better diagnosis and treatment. d、all of the above
3、which of the following choices is not included content of inquiry? a、general data b、physical checkup c、review of systems d、chief complaint and history of present illness
4、with the advent of emerging examination technologies, some people think that understanding a patient’s conditions through inquiry and physical checkup isn’t as important.
5、inquiry is a diagnostic method that a doctor takes medical history of a patient by inquiring the patient or relevant people systematically, conducts analysis and make clinical judgment.
section 2 general data and chief complaint
1、which of the following items are not included in chief complaint? a、treatment process b、time span from this onset to seeing a doctor c、pains the patient feels most d、the most apparent symptoms or physical signs.
2、which one of the following doesn’t match chief complaint? a、repetitious pains of upper abdomen last for 3 years and spitting blood about 200ml before two hours; b、urgent, frequent and painful urination last for two days; c、palpitation and shortness of breath last for two years, accompanied by edema of lower limbs for about half a month. d、recurrent right-side headache
3、multiple choices: general data of inquiry includes a、name b、gender c、chief complaint d、nationality
4、chief complaint is the symptoms and/or physical signs that a patient feels most when seeing a doctor, as well as the duration.
5、description of diabetes in chief complaint should be “polydipsia, polyphagia, polyuria, weight loss for 1 year”, instead of “diabetes for one year”.
section 3 history of present illness
1、which part of inquiry reflect clinical thought most? a、history of present illness b、past history c、c． personal history d、family history
2、which of the following isn’t part of history of present illness? a、disease onset b、condition development and evolution c、operation history d、diagnosis and treatment process
3、main characteristics of symptoms in terms of history of present illness include a、nature of lesion b、duration and severity c、factors to mitigate or aggravate d、all of the above
4、when inquiring about history of present illness,in addition to characteristics of main symptoms, doctors also need to inquire about meaningful negative symptoms as some of negative symptoms may have important effect on identification.
5、such information about a patient as mental state, dietary and sleep since he or she develops a disease should be included in general data.
section 4 inquiry of past history, review of systems, and personal history
1、which of the following is not included in the inquiry about past history? a、previous diseases b、vaccination history c、history of surgery and blood transfusion d、history of smoking, alcohol-drinking and hobbies
2、for patients who suffer from recurrent stomachache, review of systems should focus on a、respiratory system b、digestive system c、urinary system d、circulation system
3、compared with history of present illness, past history, personal history and family history are relatively less important. therefore, some students think that inquiry about “past history”and “personal history”are just perfunctory and not important.
4、review of systems is not intended to make a list of symptoms for medical record but to gain an overall understanding of the patients’ conditions and prevent neglect of previous diseases.
5、since inquiry about history of unclean sexual intercourse and sexually transmitted diseases tend to touch patients’ privacy, the doctors should take care to protect patients’ privacy.
section 5 inquiry of marital history, menstrual history and childbearing history, and family history
1、to inquire married patients about their marital history, doctors need to ask a、marriage age b、physical health of their spouse c、sexual life and conjugal relation d、all of the above
2、the childbearing history of a married lady doesn’t include: a、number of pregnancies and childbirths, and childbearing age b、history of induced or spontaneous abortion c、if she suffers from dysmenorrhea and leukorrhea d、if she had still birth, cesarean delivery and puerperal fever
3、in the form of recording menstrual history, the first item represents menarche age.
4、for a male patient, doctors don’t need inquire about his childbearing history.
5、for rare hereditary diseases such as hemophilia, albinism and psychosis, doctors need to ask about history of present illness as well as family history.
section 6 inquiry technique i
1、which of the following statements about inquiry is false a、use simple and easy-to-understand language b、gain overall knowledge but highlight the key points c、for pediatric or comatose patients, doctors may ask their custodians or persons knowing about them. d、use medical terms
2、in the process of inquiry, doctors should avoid a、ask open questions b、asking in a systematic and purposeful manner c、leading inquiry and/or calling patients to account d、encouraging patients to ask questions
3、allow patients fully state and emphasize the circumstances and feelings that he thinks are important as much as possible. only when their statement is too far away from the disease, it is necessary to flexibly turn the topic back according to the main clues of the statement, and do not interrupt them bluntly
4、“how long have you suffered from stomachache?” is an open question.
5、as to whom to inquire, doctors should directly ask patients’ family members when possible
section 7 inquiry techniques ii
1、doctors need to pay attention to language skills during inquiry. which of the following is inappropriate? a、no need to use transitional language b、keep language simple and easy to understand c、language of encouragement and praise d、appropriate body language
2、which of the following is a wrong way to inquire? a、“did you ever wake up because of urination during sleep?” b、“have you ever suffered from paroxysmal nocturnal dyspnea?” c、“your blood glucose monitoring record is done very well!” d、“it is great that you have quit smoking!”
3、which of the terms below should be avoided using? a、occult blood b、delirium c、epistaxis d、tenesmus
4、avoid using medical terms during inquiry.
chapter 3 doctor-patient communication skills
section 1 oral language skills
1、which one of the following statements is the best for doctor-patient communication? a、you are so unreasonable. b、you talk too much. c、easy, speak slowly. d、are you the patient of bed 3? come for examination!
2、which one of the following is improper for addressing a patient? a、li wei of bed 5. b、li wei , no.10. c、mr./mrs. li. d、bed 5
3、which oral expression is improper in doctor-patient communication? a、complimentary expressions b、commanding expressions c、polite expressions d、cmforting expressions
4、which one of the following is acceptable? a、do you have occult blood in stool? b、what’s the color of your stool? c、your diagnosis from the previous hospital is completely wrong. if you came to me earlier, the situation wouldn’t be so bad! d、how could it be that the doctor prescribed these doctorines for you, it was totally wrong.
5、when talking with a patient with terminal tumor about his or her disease, the doctor must be honest and tell him or her that the tumor is incurable.
section 2 body language skills
1、during doctor-patient communication, which one of the following body language is improper? a、nodding to express understanding and agreement b、smiling when telling the patient about his or her critical conditions c、maintaining eye contact with the patient d、keep an arm’s distance when communicating with a patient
2、which one of the following is suitable for having an eye contact with a patient? a、stare him or her in the eyes b、look sideways at the patient c、vision drifting around over the patient's face d、train vision on lower part of the patient's face
3、which one of the following is improper when having body contact with a patient? a、patting him or her gently in the back when the patient is vomiting b、helping the patient with limited physical mobility to get off he bed c、putting hands on the patient’s waist d、shaking hands with the patient when saying goodbye
4、which one of the following super-lingual reminder is suitable for doctor-patient communication? a、warming and soft tone b、matter of fact voice c、loud lecturing d、informing hastily
5、in the process of doctor-patient communication, it is important to use body language properly.
section 3 written language skills
1、when signing an informed consent letter, which one of the following runs against the procedure? a、both the medic and the patient must appear b、only one informed consent is needed for multiple similar operations or treatments c、if a proxy signs the informed consent, the proxy must produce the authorization letter signed by the patient to that effect d、if the patient or his or her family cannot write, he or she can sign with his or her fingerprint
2、which one of the following requirements is improper for medical written communication? a、ambiguous b、comprehensive c、professional d、clear
3、comprehensiveness of the medical informed consent letter shall include a、any possible complications b、limitations of medical measures c、prognosis of the disease d、all of the above
4、medical written language communication refers to the exchange conducted by the medics and patients using letters, pictures and graphics, etc.
5、the informed consent letter must be signed by the patient in person.
section 4 listening skills
1、which one of the following is needed for a good listener? a、attentiveness b、responsiveness c、effectiveness d、all of the above
2、which of the following is improper for an effective listener? a、what the patient said is useless b、accept what the patient said c、understand what the patient said d、record accurately what the patient said
3、which one of the following is not a responsive listener? a、“en. i understand what you said” b、“you, stop saying!” c、“can you talk about this in more details?” d、“look, this is how i understand it, do you agree with me?”
4、be a good listener, you only need to hear the patient speak of his or her disease.
5、be an attentive listener, you will stay focused on listening, try to feel in the patient’s place and never interrupt the patient’s talk without a good reason.
section 5 questioning skills
1、which one of the following is an open question? a、“do you have stomachache?” b、“where and how do you feel uncomfortable?” c、“is your stool black?” d、"is your urine red?”
2、which one of the following is a closed question? a、“do you have other questions about your treatment plan?” b、“where and how do you feel uncomfortable?” c、“is your stool black?” d、“what is the color your urine?”
3、when asking about medical history of a patient, on what matter can the medic raise closed questions? a、marital history b、personal medical history c、family medical history d、all of the above
4、which one of the following is usually used to raise a closed question? a、what b、why c、yes or no d、d.can or cannot
5、which one of the following is usually used to raise an open question? a、right or not b、why c、yes or no d、have or have not
section 6 responding and expressing skills
1、which one of the following expresses affirmation and acceptance to the patient? a、the pain during the examination cannot be such intense. b、this feeling must be real uncomfortable? c、how couldn’t you bear this ？ d、this could be your delusion.
2、which one of the following is not encouraging to the patient? a、you are thinking too much. b、i understand your anxiety, please tell me if you have other uncomfortable feelings. c、very good, do you feel uncomfortable somewhere else? d、i understood, keep talking.
3、which one of the following needs clarification from the patient? a、when did you first feel the stomachache? b、where exactly do you feel pain? c、do you feel uncomfortable somewhere else? d、all of the above
4、medical staff must accept the patient unconditionally and never express rejecting, grudging, disgusting or impatient feelings.
5、in regard of the patient’s ambiguous expression, the doctor can guess and judge on his own.
section 7 empathy skills
1、how to realize empathy? a、a.stand in the patient’s place ,feeling his or her inner world b、express understanding of the patient’s emotions and physical conditions c、make sure that the patient can feel that the medics understand him or her and help the patient understand deeper into his or her inner experience d、all of the above
2、which one of the following can effect empathy with the patient? a、this examination may make you feel uncomfortable, but you are too sensitive. b、i understood, you must be held back by something c、you will choose to accept treatment first or go to work first? d、your testing results are all good, there is no reason to feel pain.
3、how to make better use of empathy skills? a、learn to feel the patient’s feelings b、learn to listen c、learn to express respect to the patient d、all of the above
4、empathy means the doctor can feel and experience the patient’s pain through direct association.
5、empathy can enhance experience and feelings of the doctor and patients in the process of consultancy and treatment, and will play a decisive role in determining the treatment protocols.
section 8 how to inform bad news
1、which one of the following is bad news? a、the patient is in a critical condition b、massive hemorrhage happened amid an operation c、the testing report shows it is a malignant tumor. d、all of the above
2、which of the following is not a step for informing bad news? a、preparing the atmosphere and documents b、understanding cognition degree of the patient c、readying the medical staff d、choosing the right time
3、which of the following maybe is the response for being told bad news? a、poker-faced b、crying c、blaming the doctor d、all of the above
4、before informing bad news, what should you know about the patient? a、before informing bad news, what should you know about the patient? b、what the patient thinks has happened c、what the patient cares about or fears of? d、all of the above
5、when informing the bad news, which if runs away from the patient’s expectation too widely , it must be told in a hierarchical and progressive way.
chapter 4 overview of doctor-patient communication
section 1 characteristics of outpatients
1、patients have different occupations and social background, yet they have same requirements for and same attitude towards medical treatment
2、outpatients have different occupations, beliefs, degree of eduction, economic conditions, life background and medical insurance plans of different nature. these factors have direct bearing upon their cognition of their illness and their demands for medical treatment.
3、when a person’s disease involves multiple body organs or presents no clear clinical manifestations, it is necessary to conduct further examination and/or carry out mdt consultation.
4、as a window of the hospital, the outpatient clinic makes the first diagnosis. the clinical doctor is required to be highly capable of making diagnosis and giving treatment. the outpatient service is likely to result in medical dispute.
5、please summarize the characteristics of outpatients:
section 2 characteristics of the works at an outpatient clinic
1、the principles that should be observed during the communication between clinical doctors and patients: a、the principle of maintaining sincerity and empathy b、the principle of maintaining appropriateness and keeping distance c、the principle of exercising restraint and keeping silence d、the principle of leaving room for manoeuvre and addressing different listeners in different ways
2、which of the following are the characteristics of the works at an outpatient clinic? a、heavy workload of diagnosis and treatment against tight deadlines b、incoherent and risky process of diagnosing and treating patients c、strong connection between different links of giving medical treatment d、unprofessional and unsystematic diagnosis and treatment
3、body language is a form of communication between outpatient doctors and patients. doctors should appropriately use body language at proper occasions without exaggerating movements.
section 3 clinical doctor-outpatient communication skills
1、when speaking about the patient’s state of illness, the doctor should keep a sense of propriety and leave room for manoeuvre. in particular, the doctor should not speak decisively on the state of illness. otherwise, in case of an emergency, the patient and his or her family members would be caught unprepared, which is likely to lead to a dispute.
2、the entire process of diagnosis and treatment at an outpatient clinic involves multiple links such as
3、1. in which aspects are systematic and diverse aspects of the works at an outpatient clinic are manifested?
chapter 5 overview of doctor-patient communication
section 1 characteristics of emergency patients and their families
1、5 characteristics of emergency patients a、conditions are critical and risky b、disease often occurs singly c、they are often in urgent need of medical treatment d、generally poor diagnosis
2、1. as some of emergency patients are critical and quite risky,even timely treatment cannot avoid occurrence of serious consequence.
3、for critical patients who suffer from serious consequence, their family members may unreasonably put blame on medical staff members, resulting in medical disputes.
4、although some of emergency patients are critical and quite risky,there won’t be serious consequences after active treatment.
5、what are characteristics of emergency patients and their families?
section 2 features of medical emergency work
1、which of the following diseases can go through “green channel” for treatment a、acute myocardial infarction falling under cardiovascular medicine; b、respiratory failure falling under pneumology department c、stroke under neurology department; d、multiple injuries
2、emergency patients are often in critical conditions and serving them involves more complex procedure than usual, which increases the chance of doctor-patient frictions.
3、types of emergency diseases: (more patients with respiratory disorders) in winter; (more patients with intestinal infectious diseases) in summer; (more patients with injured hands) in harvest period; (more patients having bone fracture) in snowy days.
4、what are the features of medical emergency work?
5、what are the service scope of“green channel”?
section 3 “green channel” emergency service
1、what are the skills on medical emergency doctor-patient communication? a、enhance sense of responsibility b、take active and effective treatment. c、first treat and save patients with severe trauma d、stress art of communication
2、medical staff should treat the emergency patients, looking solemn and keeping silent.
3、in case that there are many patients needing emergency treatment due to a major incident, inform division of medical affairs and general on-duty office and the director in charge.
4、when treating critical patients, doctors don’t need to keep written record of important examination and explanation on critical conditions with signature by patients themselves or one of their families.
5、what are the skills on medical emergency doctor-patient communication?
section 4 skills on emergency doctor-patient communication
1、medical staff should treat the emergency patients, looking solemn and keeping silent.
2、in case that there are many patients needing emergency treatment due to a major incident, inform division of medical affairs and general on-duty office and the director in charge.
3、when treating critical patients, doctors don’t need to keep written record of important examination and explanation on critical conditions with signature by patients themselves or one of their families.
4、emergency patients are often in critical conditions and serving them involves more complex procedure than usual, which increases the chance of doctor-patient frictions.
5、for critical patients who suffer from serious consequence, their family members may unreasonably put blame on medical staff members, resulting in medical disputes.
chapter 6 doctor-patient communication in wards
section 1 notice to patients on admission, hospitalization and discharge
1、what are included in the notification given to the patient prior to his or her disposal from a hospital? a、discharge diagnosis b、guidance to ways of life c、guidance to ways of taking medicine d、guidance to follow-up visit e、all of the above
2、what are included in the notification given to the patient upon his or her admission into a hospital? a、preliminary diagnosis upon the patient’s admission into a hospital b、preliminary treatment plan c、introduction to all medical team members d、notification on the rules and regulations in the hospital e、all of the above
3、what is the preliminary diagnosis mainly based on when the patient is admitted into a hospital? answer: abc a、inquiry about medical history b、physical examination c、results of laboratory tests d、family background e、habits in daily life
4、true or false: it is not necessary for a doctor to notify a patient of the regulations and rules in a hospital, since the patient will learn about the relevant information on his or her own.
5、true or false: when phased progress is made or critical change is seen in the patient’s diagnosis and treatment, the doctor should notify the patient and patient’s family members of the present state of illness. this is “giving notification during the patient’s hospitalization for treatment.”
section 3 notice to patients on special examination and therapy
1、special examination and therapy refer to: a、examinations and therapies which are somewhat dangerous and may have adverse consequences; b、clinical trial examinations and therapies; c、examinations and therapies which are of relative high price and may cause heavy financial burden on the patients; d、examinations and therapies which may have adverse consequences or even danger to the patients due to their special constitution or critical conditions; e、all of the above
2、which of the following falls under special examination? a、chest radiography b、ecg c、abdominal ultrasound scan d、pet-ct e、physical examination
3、what are included in informing patients of special examinations and therapies? a、current diagnosis b、contents and necessity of special examinations and therapies c、special requirements and risks d、measures to deal with adverse consequences e、examination results or therapeutic effects
4、4. giving notification on serious or critical conditions involves two parts, which refer to answer: a、notification on state of illness b、informed consent c、analysis of the state of illness d、handling measures e、illness prognosis
5、true or false: intrathecal administration is a special way to administer drugs.
section 2 notice to patients on serious or critical conditions
1、which of the following items is not one of the skills of giving notification on serious or critical conditions? a、speaking with a sincere tone b、listening attentively c、seeking truth from facts d、thinking from the patient’s perspective e、watching every mood of the patient
2、what are included in notification on serious or critical conditions? a、present state of illness and prognosis b、present diagnosis c、handling measures d、relevant laws and regulations e、all of the above
3、giving notification on serious or critical conditions involves two parts, which refer to a、notification on state of illness b、informed consent c、analysis of the state of illness d、handling measures e、illness prognosis
4、2. what are included in informed consent? answer: abc a、be informed b、understand c、agree d、action e、negotiation
5、when giving notification on serious or critical conditions, the doctor should timely stop the patient from sinking into sorrow or crying if the patient is in such a mood.
section 4 preoperative conversation
1、what are included in a preoperative conversation? a、purpose and necessity of a surgery b、informed consent c、surgical scheme and cost d、surgical risks and countermeasures e、all of the above
2、what principles should be followed for a preoperative principle? a、be comprehensive and thorough b、be practical and realistic c、be individualized d、respect patient’s right of option e、risk sharing
3、a preoperative conversation should be comprehensive and thorough. it means: a、inform patient of surgical risks and complications b、inform patient of measures to deal with possible risks and complications c、inform patient of surgical cost d、inform patient of time for subsequent visit e、inform patient of specific operation procedure
4、a surgeon can make a unilateral decision on time and method of surgical operation, without the need of engaging the patient.
5、true or false: the informed consent in a preoperative conversation is the basis for the surgeon to be exempt from and mitigate responsibility.