[mdphd] GR + feedback

[Andrea Cifonelli]

Good morning,

Grand Rounds tonight at 5pm (4:30 King David’s for dinner).

Grand Rounds feedback participation is much better! Amit, I and your colleagues really appreciate the improved effort. Please keep it up. Those who completed the feedback and the bonus question, prizes are in the mail. Those who are confused about the following content, do better.

Social History Foreplay (noun):

-establishing a rapport with the patient, connecting with them based on any shared interest, and using that to get the patient to open up about their occupation, dietary preferences, physical/sexual activity preferences, living situation and anything else that comes under the social history umbrella

-implies a way of conversing with someone that allows a natural conversation about a patient's life rather than a bulleted list of prescribed questions

-the act of preparing a patient to share personal, sensitive information in a social history by establishing rapport during previous portions of the interview through behaviors and actions

-When asking somebody about their social history, starting broad, being cordial and empathetic and not jumping to specific questions from the get go.

-Building rapport with your patient and asking about general life situations first rather than medical history before diving into social history questions. Perhaps start with lighter questions, such as "where do you live? how long have you lived there, do you live alone, etc." to ease into diet and exercise and THEN ask some of the more sensitive social history questions such as alcohol/drug use and sexual history.

-in regard to patient interviews is the asking of more comfortable questions; such as occupation, daily routine, hobbies; prior to moving into more sensitive topics like sexual history. This "social history foreplay" both allows for the collection of important information, but also builds rapport with the patient and can make them more comfortable when transitioning into areas they may be less comfortable with. A key portion of social history foreplay is following what one may describe as the "foreplay" itself, is the introduction into the more sensitive area so the patient is prepared (opposed to switching directly from "what do you do for work" to "are you sexually active").

-(noun): the act of asking a patient smaller questions about their activities and habits that seem relatively unobtrusive in order to build a stronger sense of trust when eventually asking about more sensitive topics.  Example: "Dude, my doctor just jumped straight in with questions about my drug use and didn't even ask what I do for a living.  That guy has zero social history foreplay."

-Establishing a rapport with the patient while asking the easy social history questions before asking the questions that might make the patient feel uncomfortable

-Offering the patient a soothing lavender and honey back message to relax the patient enough to open up about sensitive topics. Example: When the patient asked for a cigarette after my social history foreplay message, I began to suspect that he might not have actually quit 5 years ago.

-Doing the bare minimum needed to get to the good stuff

Ex: “Sorry about your dead parents. But you seem to have a great taste in fashion, can we talk about your taste in sexual partners?”

Cheers,
Andrea

Andrea Cifonelli (she, her, hers)

Coordinator of Combined Programs and Special Initiatives
MD/PhD Program Coordinator
PREP-Up and SURF Coordinator
Postdoctoral Affairs Coordinator
College of Graduate Studies
Weiskotten Hall 3118
cifonela at upstate.edu<mailto:rheaa at upstate.edu>

In-office Wednesday-Friday, Telecommuting Monday, Tuesday and every other Friday
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