Exam (elaborations)
Usmle Step 2 Cs - Difficult Patients
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Usmle Step 2 Cs - Difficult Patients
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Usmle Step 2 Cs - Difficult Patientsanxious patient Correct Answer: encourage patient to talk about his feelings
ask about things causing anxiety
give reasonable assurance
"any pt in your situation may react this way, but i want you to know that I will do my best to address
your concerns"
angry patient Correct Answer: stay calm
don't be scared
ask about reason for the anger
give reasonable answers
"I can understand why anyone in your situation might become angry under the same circumstances, but
I'm here now and it is your time."
crying patient Correct Answer: allow patient to express feelings
wait in silence for him to finish
offer a tissue
show empathy
place hand on shoulder
"i know you feel sad, would you like to tell me about it?"
patient in pain Correct Answer: show compassion
offer help
don't repeat painful maneuvers
if patient does not allow to touch --> explain you need to perform maneuver and give reassurance
"I know you are in pain, is there anything i can do for you to help you feel more comfortable?"
"I know that you are in pain, and I want to help you. I need to examine you, though, to be able to locate
the source of your pain and give you the right treatment."
patient who can't pay Correct Answer: reassure the patient that you will provide care anyway
offer referal to a social worker
"Not having enough money doesnt mean you can get treatment. We can refer you to a social worker
who can help you find resources."
patient who refuses to answer Correct Answer: explain why it is important
if patient still refuses, skip maneuver or question and document it on PN
hard of hearing patient Correct Answer: face patient directly to allow him to read lips
speak slowly
use gestures
if hearing loss is unilateral, sit closer to hearing side
, patient doesn't know medications or I don't recognize medications Correct Answer: ask if patient has
prescription or a written list; if they don't ask if they can fax it to the office later
phone encounter Correct Answer: press speaker button to call the patient
no physical exam needed, so leave blank on PN
how to handle challenging questions Correct Answer: be honest and diplomatic
restate the issue in different words
don't give a final diagnosis
don't give false reassurance
if answer is not known, say so
pt who needs emergency surgery:
"I can't afford the cost of staying in the hospital. I have no insurance. Just give me something to relieve
the pain, and I will leave." Correct Answer: "I know that you are concerned about medical costs, but
your life will be in danger if you don't have surgery. Let our social workers help you with the cost issues."
"Should I tell my sexual partner about my venereal disease?" Correct Answer: "Yes. There is a chance
that you have already transmitted the disease to your partner, or he/she may be the source of your
infection. The important step is to have you both evaluated and appropriately treated."
An anxious patient who you suspect has been abused asks, "Why are you asking me these questions?"
Correct Answer: "I am primarily concerned about your safety, and my goal is to make sure that you are
in a safe environment and that you are not a victim of abuse."
A patient recently diagnosed with HIV asks, "Do I have to tell my wife?" Correct Answer: "I know that it's
difficult, but doing so will allow you and your wife to take the appropriate precautions to treat and
prevent the transmission of the disease."
a doorway information sheet indicates that the pt is Mr. Smith and that he presents with dixzziness, but
when you enter the room, you find a female pt Correct Answer: begin by saying "excuse me Mrs.
Smith?"
when the pt responds "No, I'm Mrs. Black." you say "oh, I think the nurse must have given me the wring
chart. Hello, Mrs. Black. What brings you in today."
remember..you must retake the vital signs, the ones on the original chart are of a different pt
A pt attempts to seduce you "Doctor, do you have time to have dinner with me at my place?" Correct
Answer: I am sorry, but that would not be permissible in the context of a doctor-patient relationship
An elderly patient says, "I think that it is normal at my age to have this problem" (impotence), or "I am
just getting old." Correct Answer: "Age may play a role in the change you are experiencing in your
sexual function, but your problem may have other causes that we should rule out, such as certain
diseases (hypertension, diabetes) or certain medications. We also have medications that may improve
your sexual function."
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