Taking a Health History: Building a Health History: Asking Difficult Questionsice

Review the Ewing (2004) questionnaire found in this week’s Learning Resources and consider the difficult questions you might have to ask when you take a patient’s health history.
Review the screening tools found in the Learning Resources and consider how you might use an app or tool to assist in screening.
Review the media programs related to a vaginal exam, pap test, and breast exam.
Review the health history guide presented in Chapter 6 of the Schuiling & Likis (2017) text and consider how you would create your own script for building a health history. (Note: You will also find the Health History Form in Chapter 6)

https://whs.bwh.harvard.edu/index.html readings

ANSWER

Taking and Building a Health History

Overview

Healthcare professionals should rely on a health history script to assess a patient’s status. These scripts should encompass questions that meet the needs and interests of the patients. This will ensure that they offer appropriate feedback that helps care professionals to provide quality services. In addition, healthcare professionals should be better positioned to develop a script that aligns with their cultural background and other personalized aspects. Overall, script questions should be relevant to ensure that patients receive appropriate care and assistance services.

Components of a gynecologic health history

A gynecological health history script should entail critical components that enable the care professional to diagnose a patient effectively. These components include the symptoms, past medical history, drug, family, and social history. The symptoms will inform the healthcare provider if the patient is exposed to a gynecological problem or not. Past medical history examines the prevalence of cervical cancer, surgical history, and exposure to sexually transmitted infections. Drug history evaluates contraception usage, antibiotics, and any other medications. Family history seeks to understand if any of the family members have illnesses like ovarian cancer and diabetes. Lastly, social history evaluates weight, occupation, home conditions, and overall health status. The targeted questions when examining these components should integrate open-ended, accurate, and sensitive (Mayfield et al., 2017). This is a key way of meeting the needs of sensitive populations like the LGBTQ (Lesbian, gay, bisexual, transgender, and queer) community.

The health maintenance guidelines for gynecological processes include screening, tests, and exams. Healthcare professionals are expected to observe these guidelines when handling patients with gynecology history. For example, diagnostic tests like a biopsy, bone density, and endometrial biopsy are undertaken for these patients. During the initial stages and follow-up assessments, these tests inform healthcare providers about exposure and successful elimination of gynecological conditions.

A Health Script for Examining Gynecological History

• What are the symptoms that you have been experiencing?
• What are your living conditions at the moment?
• Do you think these living conditions can expose an individual to gynecological conditions?
• Do you feel like your menstruation period patterns might pose a challenge for you and your overall healthcare?
• Have you ever felt like you should practice abstinence?
• Has any of your family member been against you being pregnant?
• Have you ever felt like any of your immediate and extended family member suffers from a long-term illness like cancer or diabetes?
• Have you ever thought about taking medications associated with sexually transmitted infections or any other long-term disease?

Reflection

Experiences Summary

One of the insights that I have gained when developing the health history script is observing sensitivity when asking questions. Healthcare practitioners should take caution to avoid damaging the patient’s esteem. For example, asking a patient if they have ever felt like practicing abstinence might offer the expected answer while avoiding hurting their emotions and esteem. On the other hand, a direct question might make one feel as if they are under attack. Sensitivity helps to create a supportive environment for such discussions. The healthcare provider should ensure that their interaction is supported by a viable and conducive environment that enhances openness. However, there is a dire need to use sensitive words and statements when asking these questions. As Hardavella et al. (2017) state, healthcare practitioners should effectively select words and phrases that meet patient’s expectations and needs. This will ensure that the two parties have a successful interaction. The other essential lesson that I have learned is that medical history scripts should encompass a wide range of components that allow healthcare providers to understand the patient’s issue. For example, by assessing the symptoms, social, medical, and drug histories, they are better positioned to diagnose the patient and provide suitable recommendations.

Difficulties experienced when asking questions

The most difficult element revolving around asking questions revolving around patient’s exposure to gynecological challenges is the need to be specific. For example, the desire to learn about the patient’s sexual life might be overridden by the practitioner’s question. These professionals are always looking to avoid a situation where the patients might develop discomfort with the questions asked. This makes them avoid direct questions while focusing on indirect ones that insinuate that the provider desires to learn about their sexual life. However, the patient might provide contrary information likely to affect the process. Thus, integrating specific questions is one of the major challenges experienced in the health history assessment process. The other vital challenge portrayed in this task is putting oneself in the patient’s shoes.

Healthcare practitioners are always expected to be empathetic towards their patients. This makes them provide quality solutions because they can relate to the experiences of their patients. Moudatsou et al. (2020) argue that empathetic professionals comprehend the needs of healthcare users. Therefore, they are better positioned to offer suitable recommendations because they can understand the patient’s better by being compassionate. When asking these questions, I showed the patients my emotional side through non-verbal cues like physical appearance. I believe that this is a wrong move that might send a different signal to the patients. In the future, I always ensure that I avoid directly indicating to the patients that I understand and recognize the challenges that they are experiencing. I believe that this will enhance my connection with my patients during diagnosis.

References

Hardavella, G., Aamli-Gaagnat, A., Frille, A., Saad, N., Niculescu, A., & Powell, P. (2017). Top tips to deal with challenging situations: doctor–patient interactions. Breathe, 13(2), 129-135.

Mayfield, J. J., Ball, E. M., Tillery, K. A., Crandall, C., Dexter, J., Winer, J. M., … & Ashraf, K. (2017). Beyond men, women, or both: a comprehensive, LGBTQ-inclusive, implicit-bias-aware, standardized-patient-based sexual history taking curriculum. MedEdPORTAL, 13.

Moudatsou, M., Stavropoulou, A., Philalithis, A., & Koukouli, S. (2020, March). The role of empathy in health and social care professionals. In Healthcare (Vol. 8, No. 1, p. 26). Multidisciplinary Digital Publishing Institute.