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Communicate effectively with patient and family

Learner Task: Three weeks later the patient presents to the emergency department with acute vaginal bleeding. Your colleague tells you the following patient history, physical exam findings and laboratory results when you arrive in the emergency department:

  • The patient presented to the ER one hour prior. This patient is known to the Gyn service. She has documented uterine fibroids on US and had a Levonorgesterel IUD placed three weeks ago. She reports soaking through 2-3 large pads per hour for the past five hours. She reports dizziness, lightheadedness, and fatigue. She last ate four hours prior. She denies nausea and vomiting. She denies pain. She has not had intercourse since the IUD insertion. She denies trauma. She denies fever.
  • Physical exam: 110/60, 83bpm, 18, 36C
  • Gen: pale, comfortable. Tired appearing
  • HEENT: dry mucous membranes
  • Heart: regular, mild tachycardia
  • Lungs: CTA bilaterally
  • Abdomen: palpable mass to 2 cm below umbilicus.  Midline, mobile, nontender. No rebound or guarding.
  • Groin: negative
  • Pelvic: normal vulva, vagina and cervix. Clot in vagina. Active bleeding viewed from cervical os.
  • Bimanual exam: no CMT; uterus enlarged to 16-week size with irregular contour
  • Lab: Hg 6.2, PT/PTT/INR normal, Beta-hCG is negative, type and screen drawn, chem-7 normal

You call your attending and present this patient. You and the attending decide to send the patient to the floor for stabilization, with plan for hysterectomy once this is achieved. Communicate to the patient and her family the plan to send the patient to the floor for stabilization, and then hysterectomy once stabilization achieved.

Educator Checklist: Interpersonal and Communication Skills and Professionalism
Mark the appropriate column to indicate whether the learner included each element in his or her response. When completed, tally the “Included” column to calculate the learner’s score.

Communication: Gathering Information Included =1 Not Included =0
Greets patient appropriately, name, role (My name is ______ and I am the third-year medical student on your treatment team)
Sits down
Assumes a comfortable interpersonal distance
Makes eye contact
Is easily understood, speaks clearly and slowly
Asks clearly worded and understandable questions, one question at a time
Asks what the patient already knows about a hysterectomy or what their understanding of the situation is
Explores the patient perspective by asking: How are you doing with this? How does this make you feel? How is this impacting your life?
Is well-prepared for the encounter, obtains information in a logical, systematic, orderly progression
Avoids the use of medical jargon
Listens attentively, follows patient needs and prompts, does not interrupt
Asks if the patient or family have questions
Appears empathic, emotionally supportive to patient, statements of empathy, validates patient concerns, emotions, uses body language
Communication: Providing Information  Included =1 Not Included =0
Summarizes information for patient (reviews anemia, uterine size, failure of IUD, explains medical condition: fibroids)
Provides information about the rationale for recommending hysterectomy
Provides information on next steps (labs, consent, etc.)
Provides information on the logistics of hysterectomy (2-3 hour surgery, 2-3 day hospital stay, here is how it is performed, risks, benefits, alternatives)
Asks for questions, clarifies patient understanding
Revisits patient agenda (Have we covered everything you wanted to discuss or answered all your questions?)