Objective: Approach the care of patients as a cooperative endeavor, integrating patients’ concerns and ensuring their health needs are addressed.
The interview, more times than not, provides the most useful information for clinical decisions. The patient entrusts the practitioner with intimate details of their life while also indulging the pertinent history related to their chief complaint. This exchange allows for the practitioner to integrate the subtle life modifiers with the objective clinical history therefore creating a delicate rapport for holistically addressing the patients’ needs. However, some details may be superfluous and rather than shed light, may create confusion. In psychiatry, this can be particularly difficult when the linear reasoning of a patients’ psyche is in question. During my mini-I, I challenged myself to learn how to strike a balance between the importance building good rapport and obtaining pertinent information with acutely manic patients.
“How are you doing this morning?” I ask our new patient who our team suspects may be manic, along with some narcissistic personality traits. “Well, I’d be better if I was able to sleep without my roommate making all that noise… and I tried to get my iPad but the nurses aren’t listening to the order you gave them… there is no intellectual stimulation in this place… I was a respected researcher… I was on the board of…. I don’t think you all know what’s wrong… I feel like I’m TRAPPED IN A CAGE!” A flurry of comments and repeated statements is what I would receive from the simplest of questions. This was my first interview with a manic patient. I was overwhelmed—not knowing where and how to steer the conversation in a productive direction without disrespecting the patient or injuring his inflated ego. So, to effectively interview this patient, I chose to make this a SMART goal for this rotation.
SMART Goal Reflection
I scoured the internet for interviewing methods for manic patients to no avail. Thinking more broadly, I realized that interrupting patients has been a consistent issue for me throughout some of my medical training. I truly care about the concerns of my patients and too often allow too much time to air out their grievances. So instead, I was able to find a simple pneumonic used to address and redirect patients in any setting in a professional and compassionate manner—The 7 Cs.
Calm down, Connect with the patient, show Concern, identify a Cause, Comfort the patient, agree to a Contract, and maintain Continuity.
On further observation, I also noticed this method, while not as discrete, being employed by my attending and my resident by forcefully interjecting as a means to connect and redirect our patient. Keeping this strategy and the 7 Cs in mind, I was able to cut down our normally long and drawn out interviews steadily by 15-30 minutes. I was ecstatic. While I was not able to completely exactly achieve my SMART goal, I was able to make significant improvement.
Mini-I Feedback
Throughout the remainder of the year, I continued to employ this strategy on other talkative, combative, or anxious patients. By learning the 7 Cs I now have a more discrete method to refer to when facing the challenge of being efficient and effective during residency. In addition, this will serve as an objective point to pass down to future medical students or residents who struggle with this concept in a variety of clinical settings.