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DOMAIN 1-Communicating with the Patient

Identifying the Problem

  1. Bring relevant medical and psychosocial knowledge to the encounter
  2. Elicit complete and accurate information
  3. Perceive essential data
  4. Form and test hypotheses (problem-solving)
  5. Identify psychosocial and other contextual variables-Role of family members and significant others, support systems, psycho-emotional states, developmental states, altered cognitive states, stigmatizing conditions, socio-economic problems, language and culture, sexual orientation, spiritual/religious, other limitations in ability to communicate

Developing and Maintaining Relationships

  1. Elicit the patient's perspective
  2. Respect the patient as a unique individual
  3. Demonstrate professionalism

Education and Counseling

  1. Assess health literacy, using the psychosocial and contextual variables identified above.
  2. Use non-technical language while explaining the recommended course of action
  3. Elicit and address questions
  4. Confirm patient's/family member's understanding
  5. Negotiate a mutually agreeable treatment plan
  6. Educate patient about the implementation of treatment plan
  7. Facilitate behavioral change

Specific Applications

Settings
New patient interview, established patient interview, Chronic condition, Non-adherent patient, health maintenance visits, problem-focused interview (acute), family interview, patient interview utilizing medical interpreter, telephone interview, e-mail communication with patient.

Situations
Advance Directives, Bad News (diagnosis, errors, sub-optimal results, etc.), Informed Consent, Limitation of Treatment (DNR, DNI, etc.), Organ and Tissue Donation, HMO/Insurance Limitations, abusive relationships, substance abuse, genetic counseling.



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Macy Initiative on Health Communication
Division of Primary Care
NYU School of Medicine
550 First Avenue New York, NY 10016
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Phone: (212) 263-3071 Fax: (212) 263-8234
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