08/12/2015 Interviewing Skills;

09:30 – 11:30 Filipino Medical Language

YL6: 01.07.01 Principles and Perspectives
Aileen B. Pascual, MD, DFM, FPAFP

OUTLINE Patient sometimes has a

I. Medical Interview II. Basic Medical Onset, location, duration, different agenda than your
A. Clinician-Centered Terminologies quality, quantity, own
Interviewing vs. A. Body Parts (Mga aggravating factors, It is all about understanding
Patient-Centered Bahagi ng relieving factors, timing, the unique experience of
Interviewing Katawan) etc. your patient with the
B. Interview Setting B. Common Diseases disease
C. Integrated Medical (Mga Karamdaman)
Interviewing C. Conducting Patient-Centered Approach
D. Structure of a Examinations • Patients often do not seek health care only because of a
Medical History (Pagsasagawa ng symptom
E. Applying the Eksaminasyon) • Patients usually bring more than one concern to their
Biopsychosocial Review Questions clinician
Approach to Clinical Freedom Space • Allowing the patient to tell her or his symptom story is
Practice therapeutic and diagnostically useful
• Patients do not want us to try to “fix” everything they tell
I. MEDICAL INTERVIEW us about

• Process of gathering and sharing information in the (2018 Trans)

context of a trustworthy relationship that takes into
account both disease (if present) and illness B. INTERVIEW SETTING
→ Disease refers to a biomedical process inside the body
or simply the pathology • Privacy
→ Illness is a subjective perception of a patient and is the • Comfortable surroundings
experience of having the disease
• Appropriate seating arrangement
→ You can have a disease without being ill. It is also
possible to be ill without having a disease (e.g.
hypochondriac).

A. CLINICIAN-CENTERED INTERVIEWING
VS. PATIENT-CENTERED INTERVIEWING

Figure 2. Seating arrangement in (a) is very formal while in (c) it is

too open. The best seating arrangement for a medical interview is
Figure 1. Integrated understanding of patient disease and illness is (b) wherein you are close to the patient but there is a sense of
important in medical interview (Dr. Pascual’s presentation) formality. (Dr. Pascual’s presentation)

Not discussed but it was emphasized that an integrated • Other notes:

understanding is the key in interviewing → Chairs should have the same height
→ If there is more than one patient, a V-shaped seating
Table 1. Clinician-centered vs Patient-centered Interviewing arrangement without a table is recommended
Clinician-Centered Patient-Centered ! Some patients must be closer to the doctor than
Interviewing Interviewing others
Your main agenda is Understanding the illness
diagnosis as a whole
You are looking for
How does s/he feel about
something specific (i.e.
the disease?
signs and symptoms)
Understanding the signs
His/her ideas and
and symptoms to obtain
perception about the
your agenda to diagnose
disease
and heal the patient

YL6: Group 7: Cabatuando, Corpuz, Dela Rosa, Elefante, Gonzales, Guanzon, Macrohon, Salazar, Teng, Turalde, Uy 1 of 4
01.07.01
 C. INTEGRATED MEDICAL INTERVIEWING → Indirect lead – “Go on”
• Reflecting
→ Content
→ Perception check
→ Feelings
→ Non-verbals
Source: 2019 Trans (YL5: 1.4)

D. STRUCTURE OF A MEDICAL HISTORY

Beginning the Interview

• Greet the patient by name
• Ask the patient to sit down
• Introduce yourself
Figure 3. Framework for Integrated Medical Interview. Foster a • Explain the purpose of the interview
patient-centered interview first in order for the patient to tell his story • Explain the need to take down notes (if needed) and ask if
about his illness. Once you get his HPI and other pertinent data this is acceptable
about the disease, shift from being patient-centered to a clinician-
centered interview so that you can incorporate your medical
expertise to better understand the disease of the patient.
Body of the Interview
(Dr. Pascual’s presentation) • Basic Information about the Patient
→ Ask and make sure the following are accurate
• The goal is to integrate between clinician-centered and ! Name
patient centered interviewing skills ! Sex
→ Assess the Illness Experience ! Age
! Feelings ! Civil Status
! Ideas and explanations of the cause ! Race (if relevant)
! Functioning ! Address/Place of Origin
! Expectations ! Informant, Reliability
→ Questions to Ask • Chief Complaint
! Do you have any specific fears or worries right now? → Description of the present problem
(May kinakatakot ba kayo o may pinag-aalala?) → As much as possible use the exact words the patient
! Do you have ideas about what might have caused told you
the illness? ! Ex. Dizziness (“umiikot ang paligid”), abdominal pain
! How has your illness affected your day-to-day life? → At times, your patient will tell you “Magpapacheck-up”
(Paano ito naaapektuhan ang trabaho o pag-aaral?) • History of Present Illness (HPI)
! What have you had to give up because of your → Details about the chief complaint
illness? → Let the patient tell the story
! How does this illness affect important people in your → Ex. If the patient complains about pain, ask the
life? following:
! Do you have expectations about how doctors can ! Chronology
help? − “Kailan ba nagsimula?”
! What are your expectations about what might ! Location
happen with this illness? − “Saan ba masakit? Sa sentido (temples)?”
→ Key Points ! Radiation
! Maintain a positive atmosphere, warm manner, good − “Saan ba ito kumakalat?”
eye contact ! Quality
! Use open questions at the beginning
− “Paano and sakit nito? Parang hinihiwa ba o
! Listen carefully
tinutusok? Parang ginagasgas?”
! Be alert and responsive to verbal and non-verbal
! Severity/intensity
cues
! Timing
→ Use Active Listening Skills
− Sudden or gradual? Acute or chronic?
! Attending
! Relieving/aggravating Factors
! Bracketing
! Other associated symptoms
! Leading
! Medications taken to relieve symptoms
! Reflecting
→ Why consult now?
! Probing
! Psychosocial context
− “Ngayon lang ba nagkaroon ng panahon? Ng
REVIEW:
pera? Ng pagkakataon?”
• Attending
! Patient’s understanding of the disease
→ L – Lean forward
− Explain and make sure that the patient
→ O – Open stance understands his disease
→ V – Voice of compassion → As patient tells you his HPI, you shift from being
→ E – Eye Contact patient-centered to clinician-centered
→ R – Relax ! You have to be more focused on how the symptoms
o
→ S – Sit at a 40 angle developed
• Bracketing − Use your medical expertise to know more about
→ Setting aside appetite for gossips, tendency to interpret, the disease and its pathology
feelings, biases and prejudice, judgment, experience − Sometimes, it depends on what you know as a
• Leading clinician
→ Direct lead – asking specific questions • Past Medical History (PMH)

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 → This is a bit tricky because the patient tends to repeat ! Use of contraception
his HPI instead of his PMH → Obstetric History
! Ex. “Nagkaroon na po ba kayo ng sakit dati?” Patient • Stakeholder Analysis
then narrates the history of his present illness and → Stakeholder
not the PHM you’re looking for. “Ahh oo. Noon pang → Stake/WIIFM
1975 ganito na nangyari sa akin.” → Stand on Intervention
→ Doctor has to focus on the following questions to get → Intensity of Stand
the PMH → Degree of Influence
! Past medical problems or disorders → Insight or Action
! Prior hospitalizations/surgeries
− “Naospital na po ba kayo dati? May mga binigay Ending the Interview
po bang reseta sa inyo?”
• Summarize what the patient has told you
− Exact details about the surgery (exact date and
procedure) are hard to obtain. Just ask, “May • Ask if your summary is accurate
pagkakataon po bang naoperahan kayo dati? • Ask if the patient would like to add anything
Para saan?” • Thank the patient
! Allergies
− Medicines, food, etc. E. APPLYING THE BIOPSYCHOSOCIAL
! Current medications APPROACH TO CLINICAL PRACTICE
− “Mayron po ba kayong gamot o maintenance na
iniinom sa ngayon?” • Relationships are central to providing health care
! Present laboratory or ancillary tests • Elicit the patient’s history in the context of life
• Pediatric Patients circumstances
→ Birth or Maternal History • Decide which aspects of biological, psychological, and
→ Immunization History social domains are most important to understanding and
→ Nutritional History promoting the patient’s health
→ Developmental History • Provide multidimensional treatment
• Family Medical History (FMH)
→ Diseases II. BASIC MEDICAL TERMINOLOGIES
! Hypertension, Diabetes, Bronchial Asthma, Cancer
! Childhood diseases A. BODY PARTS
! Deaths in the family (MGA BAHAGI NG KATAWAN)
→ Family history that is related to the patient’s chief
complaint Table 2. Basic Filipino-English Terminologies for Body Parts
! May iba ba sa pamilya na nakakaranas ng sakit mo? Filipino English Filipino English
• Personal Social History (PSH) Popliteal
Alakalakan Kulubot Wrinkles
→ Occupation Area
→ Level of education Anurang Fallopian
Kuyukot Coccyx
! Ano ho ba ang natapos nila? Itlog tube
→ Smoking (include exposure) Anit Scalp Labi/Nguso Lips
→ Alcohol intake Apdo Gallbladder Lapay Pancreas
→ Substance Abuse Lalagukan/ Esophagus/
Atay Liver
→ Physical Activity Lalamunan Throat
→ Environment/Household Baga Lung Leeg Neck
! Type of dwelling Ligament/
Bagang Molar Litid
! Household members Tendon
! Water source Balagat Collarbone Mata Eyes
! Electricity Matres/
Balahibo Fine hair Uterus
! Garbage disposal Bahay-bata
! Exposure to toxins/biohazards Balakang Hips Noo Forehead
→ Access to health care Balbas Beard Ngalangala Palate
! Kung may nagkakasakit sa pamilya ninyo, saan niyo Balikat Shoulder Nunal Mole
po siya dinadala? Balintataw Pupil Palasingsingan Ring Finger
→ Health care financing Kidney/
! Sino po ang nagbabayad ng mga bayarin niyo? Bato Kidney Palad Palm
• Reproductive & Obstetric History stones
→ Menstrual history Batok Nape Pali Spleen
! Last menstrual period Bayag Testicles Panga Jaw
− Kailan ka huling nagkaregla? Bigote Mustache Pangil Canine
! Previous menstrual period Urinary
− Kailang yung regla bago nung huling regla? Biloy Dimple Pantog
Bladder
! Age of menarche Binti Leg Patilya Sideburns
− Anong edad ka unang dinatnan ng regla? Bisig Arms Paypay Scapula
! Menstrual interval / duration Bituka Intestines Pilikmata Eyelashes
− Regular o irregular ba ang regla niyo? Biyas Legs Pisngi Cheek
− Ilang araw tumatagal? Bosyo Thyroid Prostata Prostate
− Gaano karaming napkin ang ginagamit niyo? Braso Arm Pulso Pulse/Wrist
→ Sexual History Bukung-
! Age at first coitus Ankle Puso Heart
bukong
! Number of sexual partners Bulalo Bone Pusod Navel
! History of STIs

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 Marrow REVIEW QUESTIONS
Hypogastric
Bulbol Pubic Hair Puson
area 1. Medical interview is the process of gathering
Bumbunan Fontanelle Pwerta Vagina information in the context of trustworthy relationship.
Gluteus The terms disease and illness are interchangeable.
Bungo Skull Pwet
Maximus a. First statement is true; Second statement is false
Buto Bone Sakong Heel b. First statement is false; Second statement is true
Daliri Finger Sentido Temple c. Both statements are true
Dibdib Chest Sikmura Stomach d. Both statements are false
Dila Tongue Siko Elbow 2. When interviewing, it is important only to arrive at the
Inguinal differential diagnosis. What element is missing in the
Dugo Blood Singit statement mentioned?
area
Gilagid Gums Suso Breasts a. How a patient feels about the disease
Gulugod/ Tadyang/ b. Agenda of the patient
Spine Ribs c. Signs and Symptoms
Guyugod Kastilyas
Gulung- Adam’s d. Both a and b
Tagiliran Side 3. Which is not an Active Listening Skill?
gulungan apple
a. Probing
Middle
Hinlalato Talampakan Sole b. Reflecting
Finger
c. Following
Hinlalaki Thumbs Talukap Eyelids
d. Bracketing
Hinliliit Pinky Finger Tainga Ears
4. At the beginning of your interview with a patient, to
Hintuturo Index Finger Tigyawat Pimple get his HPI and other pertinent information about the
Hita Thigh Tilaw/Kuntil Uvula patient’s disease, you, as his physician, must foster
Inunan Placenta Tinggil Clitoris which type of skills?
Kalamnan Muscle Titi/Ari Penis a. Patient-centered skills
Kalingkinan Small toe Tiyan Belly b. Clinician-centered skills
Kamay Hands Tuhod Knee c. Both a and b
Kasukasuan Joints Tumbong Rectum d. None of the above
Kilay Eyebrows Turnot Nipple Hair 5. True or false. Knowing the time and cause of the
Underarms/ patient’s current illness is part of PMH.
Kili-kili Ugat Nerve/BV
Axillary a. True
Kuko Nail Utak Brain b. False
Lymph 6. True or False: Probe all of the patient’s family
Kulani Utong Nipple
nodes sickness during history taking.
a. True, it is important.
B. COMMON DISEASES b. False, probe only for sickness related to the patient’s
(MGA KARAMDAMAN)* chief complaint.
*Not discussed during the lecture but are included in Doc Aileen’s 7. What day should you specify for when asking for the
Powerpoint Presentation last menstrual period?
a. First
Table 3. Basic Filipino-English Terminologies for Common Diseases b. Last
Filipino English Filipino English c. The most painful day
Beke Mumps Manas Edema d. Middle
Bungang Rash d/t prickly Matang
Dry eyes
araw heat manok
Buwa Uterine Prolapse Pantal Rash b, b, a
Galos Scratch Pasa Bruise (signs and symptoms is necessary to arrive at the differential diagnosis), c, a,
biomedical process while illness is the experience of having the disease), d
Noisy Breathing
Halak Pigsa Boil information in the context of trustworthy relationship; Disease refers to the
in children Answers: d (Medical interview is the process of gathering and sharing
Kulani Lymph Nodes Sipon Colds
H-Mole/ Molar
Kyawa Sugat Wound FREEDOM SPACE
Pregnancy
Lagnat Fever Tigdas Measles
Tigdas German Just for fun:
Mamaso/ Label the body parts using Filipino terms
Impetigo hangin Measles
Talipaso
Ubo Cough

C. CONDUCTING EXAMINATIONS
(PAGSASAGAWA NG EKSAMINASYON)*
*Not discussed during the lecture but are included in Doc Aileen’s
Powerpoint Presentation

• Pagkuha ng pulso
• Pagbilang ng paghinga
• Pagkuha ng blood pressure
• Pag-eksamin ng...puso, baga, tiyan, etc.
• Hinga ng malalim
• Pigil ang paghinga

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