Standardized Patient Materials

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___________________________________________________

Open SP Training
Materials

John Harrison

SP Training Materials^

 

CASE SUMMARY: 

The patient is an 80-year-old man who is slightly hard of hearing. He has hypertension, hyperlipidemia, type 2 diabetes complicated by mild renal insufficiency and peripheral neuropathy, and has also developed mild CHF over the past 10 years. He is coming to see his physician because of two recent falls. One month ago, his doctor increased his Lisinopril from 10-20 mg because his blood pressure was 154/90.

Your challenge as the Simulated Patient is threefold:

  1. Appropriately and accurately reveal facts and findings related to Mr. Harrison’s complaints, ideas, beliefs and expectations
  2. Observe the resident’s behavior while you are performing as Mr. Harrison; and
  3. Accurately recall the resident’s behavior and accurately complete the performance checklist


PRESENTATION/EMOTIONAL TONE:

You are an 80-year-old, middle class Caucasian man. You are casually dressed in trousers, plaid shirt, and wearing a baseball cap. You are well groomed with no visible signs of illness. You appear a little physically fragile with an air of slight anxiety. You are cooperative, but not overly forthcoming with answers and questions. You make frequent eye contact and appear friendly.  You are slightly hard of hearing, and once in a while your answer to a question will not make sense because you didn’t hear the question properly.

Beginning of Encounter:

In response the question, “What brings you in today,” you answer in exactly the following words:

First, Well, probably not much, really. It seemed like it was time to come in…and, well, I’m just not feeling as strong as usual – and my balance is off. A couple of times recently I have felt off-balance – and the next thing I know I’m on my way down and am trying to get myself up off the floor.” 

The resident will likely follow-up with specific questions regarding your symptoms, underlying medical problems and medications. These questions should be answered with simple responses to the direct questions. You should not offer information unless directly questioned by the resident.


HISTORY OF PRESENT ILLNESS/COMPLAINT:

You have been seeing your current doctor at the Family Medicine Clinic for 10 years. You had a general physical exam (including blood work) one month ago. At that time, the doctor told you that your blood pressure was a little elevated and that your diabetes needed some attention, but your kidney function and cholesterol were doing pretty well. S/he sent you for an echocardiogram because of some fatigue and decreased exercise tolerance. It showed mild CHF, but it had not worsened since the last one several years ago. S/he increased your Lisinopril from 10-20 mg and doubled your Glucotrol XL to 10 mg twice daily.

You find that if you have been standing for a long time or get up quickly you feel lightheaded.  You also have been finding it difficult to walk with confidence. You have fallen twice, never with any loss of consciousness. You find that you trip more easily and have to concentrate much more on your walking. You feel as if you can’t trust your feet and are having a harder time recovering your balance once you start to fall. You feel better if there is someone walking beside you in case you lose your balance. This bothers you – you have always been self reliant and want to maintain your independence as long as possible. You have always enjoyed your solitary morning walks. They have been an important source of peace for you.

You also get more short of breath on exertion and feel that your energy is generally decreased.  About two years ago, you started having a bothersome burning pain in both feet. However, it is only since the Lisinopril was increased that you have had to stop your morning walk.

You have longstanding decreased hearing in both ears, but have not felt it necessary to be fitted for hearing aids yet.

Your wife sets out your medicines and you take them as prescribed, although you are not always sure they are doing anything. Overall, your blood pressure has been good when you are taking all your medications – around 110/80.


General Questions:

You have difficulty hearing and if you do not hear the resident clearly, you should say something like (“Excuse me?” or “I didn’t quite get that.” or “Could you say that again, please?” or answer what you thought you heard).

You have always tended to downplay your symptoms, but you are frustrated with your tendency to feel off balance. (“I feel like an old man, staggering along.)

Your wife always sets out your pills, so you don’t know all the names and doses. (“There used to be 6, but now there are 7 – 1 for blood pressure and 3 for diabetes in the morning and 1 for cholesterol and now 1 for diabetes at bedtime. And the water pill– and the blood pressure medicine got increased last time I was in.)
If the resident says something like:  “Tell me about your feeling of being off balance.” you would respond with…

“When I get up suddenly, I feel like I might faint – like I need to sit down. And when I am walking, at times I just don’t seem to have very good balance. A few times, when I have gotten up too quickly, I have lost my balance and fallen.”

If the resident asks “Does the room feel like it is spinning around you?” you answer “No.

If the resident asks “Have you ever hurt yourself when you have fallen? Hit your head?” you answer No.

If the resident asks “Do you remember falling? Do you think you have ever lost consciousness with your falls?” you answer “No, I have not lost consciousness.”

If the resident says something like: “How are you feeling overall?” you would respond with…

“I am a little more tired than I would like to be.”

If the resident says something like: “Do you have any chest pain or shortness of breath?” you would respond with…

“I did get short winded when I was walking in here from the parking garage – but no chest pain.”

If the resident says something like: “Are you taking your medicines?” you would respond with…

“Oh yes – my wife makes sure of it.”

If the resident asks you about any other changes in your medications, over-the-counter medications or supplements, you would respond with: “I just take what I am prescribed – that’s enough pills!”

If the resident asks something about your beliefs, ideas, feelings, or expectations about what is going on with you, you would respond with:

“I think it is important to take the medication that you give me – I know it is important to prevent more problems. But it just seems to be giving me more problems now. I am really worried about falling, and I really enjoy walking – I have always done it, and I want to keep doing it as long as I can.”


PAST MEDICAL HISTORY:

(The resident will also have this information to review prior to the encounter)

Overall Health:

You feel that your health is pretty good despite having to take a few medications. Your wife tries to make you eat a healthy diet. You walk around the neighborhood in the morning. You both go for a walk in your neighborhood after dinner most nights. You keep your regular appointments with your doctor. You have had two normal colonoscopies in the past. You see the ophthalmologist every year. You have had your Pneumovax (at age 65) and got a flu shot in October. You get a flu shot every year. You have also had a Zostavax immunization.

Prior Illnesses:

Bilateral hearing impairment (>20 years) thought to be due to working around loud farm equipment
Hypertension (30 years)
Hyperlipidemia (17 years)
Type 2 Diabetes Mellitus (15 years) with retinopathy
Chronic kidney disease (12 years)
Pneumonia 2004
CHF with EF 40% on echo 2009

Hospitalizations:

Pneumonia  2004
Inguinal hernia repair 1990

Medications:

Lisinopril 20 mg daily
Metformin SR 1000 mg 2 tabs daily
Glipizide XL 10 mg twice daily
Lipitor 10 mg daily
Lasix 20 mg daily
Baby Aspirin daily


SEXUAL HISTORY:

You have been in a monogamous relationship with your wife for 55 years.


LIFESTYLE/HABITS:

Diet and Exercise:

Generally a balanced meat, potato and vegetable diet. Your wife has been baking rather than frying meat and serving more vegetables since you got diabetes. You eat mostly chicken and fish. You do like pie – and gravy on your potatoes when you get the chance.

Alcohol:

A beer now and then.  About 3 per week.

Smoking:

None for the past 15 years. Smoked 1 pack/day for 45 years before that.

Caffeine:

You drink 1 cup of regular coffee in the morning.

Hobbies/Interests: Add personal experiences here

Education:

You completed high school at age 18. You have no formal degree beyond high school.

Occupation:

You grew up on a farm. You worked as a sales clerk at a hardware store after high school and started farming on your own at age 25.

Living Situation:

You live with your wife. You still drive. You live in a one floor bungalow in a safe neighborhood and have a small yard with a garden.


FAMILY HISTORY
:

Mother: Your mother died at the age of 82 of “heart problems.”

Father: Your father died at the age of 83 of lung cancer. He was a heavy smoker most of his life.  You had a good relationship with both parents.

Siblings: You have one brother who is 84 and has blood pressure and cholesterol. He had surgery for colon cancer 2 years ago and is doing well. He lives in Pennsylvania. You have one sister (Martha) who, you think, is relatively healthy. She is 78 and also lives in Pennsylvania.  You are not very close and see each other rarely.

Children: You have two sons (Steven and Mark) and 5 grandchildren. Mark lives in North Carolina and calls every 2-3 weeks. Steven lives 1 hour away and you see him and his family (3 children) about once a month. You are close to your children and feel you could call them (especially Steven) if you needed something. Both Steven and Mark and their families were home for Christmas.


PERSONAL HISTORY:

You grew up in a middle class farming family in Pennsylvania. You met your wife while working as a clerk in a hardware store as a young man. You married and moved to Virginia where your wife’s family lived. You had a cash crop farm for 40 years and moved from the farm to a small house in Charlottesville after you retired.

You made a reasonable living farming, although there were certainly some difficult years. You are quiet by personality, but have been well respected by your community. You like to tinker at odd jobs, fixing small motors and generally just staying busy. You are an elder at your church and attend regularly. You have been satisfied with your home life and are enjoying retirement.

Your wife has always been the homemaker and she does all the cooking, manages your medications and doctor appointments, and also has the most regular contact with your children.  She has arthritis in her knees and hips and high blood pressure, but generally manages very well. You rely considerably on your wife.


FEELINGS, IDEAS AND EXPECTATIONS ABOUT YOUR HEALTH:

It is important for you to remain independent. You believe it is important to take medication as prescribed to prevent disease complications, but you are not sure it is worth it if it affects your ability to function as you would like. You are willing to discuss the pros and cons of this with the physician, but if forced to choose, you think it is very important for your personal well-being to continue your morning walks for as long as you can.


PHYSICAL EXAMINATION:

Residents will likely perform an examination.  This may include looking in your eyes with an ophthalmoscope, listening to your heart and lungs with a stethoscope, testing your reflexes with a reflex hammer, assessing your balance and gait and assessing sensation in your feet (Refer to the “Standardized Patient Checklist”  and the “Guide to the Checklist” for details).

Your reflexes are normal at your knees, but decreased in at your ankles.

Your feet and lower extremities are numb to pinprick and light touch (you can’t tell the difference) about half way to your knees and you do not have vibration sense in your feet or ankles. You do have vibration sense at the knee.

When the resident asks for you to arise from the chair, you have to use your hands to push up from the chair and you will waver a bit when you first stand up. After about 10 seconds, you will stand without wavering. When you sit down, you have to use your hands to guide yourself down softly or you “plop” from several inches away from the seat cushion – your hip muscles are too weak to guide you gently into the chair.

When the resident assesses your gait, you will have a slightly wide-based gait and will step carefully, but will not stagger or fall. When the resident assesses your balance, you sway a little, but don’t fall or stagger. You do keep your feet shoulder-width apart.

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Open Resident
Instructions

CLINICAL PERFORMANCE EXAMINATION (CPX)

Resident Instructions^

 

Station Length:          20 minutes maximum

Patient Name:            John Harrison

Resident Instructions:

John Harrison is an 80 year old man with hypertension, hyperlipidemia, type 2 diabetes, mild renal failure and mild CHF.  One month ago you saw him for a general physical exam (including blood work). At that time he was feeling fatigued on exertion.

BP 154/90, WT 92 kg and other vitals stable. His exam showed loss of protective sensation in his feet to the monofilament test but was otherwise normal. HgA1c 8.4, TCHOL 180, TG 135, HDL 32, LDL 130, creat 1.4 and the rest of chemistry and CBC normal.

Echo showed no change from previous – mild CHF with LVEF 40% and no valvular abnormality. Patient has a colonoscopy scheduled for next month. 2 normals in past – the last 12 years ago. Patient had a flu shot this year and got his Pneumovax at 65 years of age. You increased his Lisinopril from 10-20 mg and doubled his Glucotrol XL to 10 mg twice daily.

He is coming to see you because he has had 2 recent falls and is overall feeling less robust than normal.

Today his weight is 91.5kg and BP 110/80, RR18, HR 72, temp 37.1.
Chronic bilateral foot pain 2/10.

You review the patient’s last note which reveals the following:

7/10/09

Reason for visit:          Preventive visit

PMHX:

Bilateral hearing impairment (>20 years)
Hypertension (30 years)
Hyperlipidemia (17 years)
Type 2 Diabetes Mellitus (15 years) with retinopathy
Chronic kidney disease (12 years)
CHF with EF 40% on echo 2009

Past Hospitalizations

Pneumonia 2004
Inguinal hernia repair 1990

Medications:

Lisinopril 20 mg daily
Metformin SR 1000 mg 2 tabs daily
Glipizide XL 10 mg twice daily
Lipitor 10 mg daily
Lasix 20 mg daily
Baby Aspirin daily

Social Hx :

Retired farmer
Lives with wife who helps with meds – children live away, but involved
Lives in 1 floor bungalow
Likes to walk
Etoh – 3 beer/wk
Tobacco – 45 pack years. Quit 15 years ago.

Family Hx:

m. d. 82 – ‘heart problems”
f. d. 83 – lung ca, smoker
brother. 84 – htn, lipids, colon cancer – doing well
sister. 78 – healthy
2 sons, 5 grandchildren all healthy

Preventive Health:

Colonoscopy normal x2 (last 2005)
See ophthalmologist yearly
Pneumovax at age 65
Flu shot yearly

ROS:

Fatigue, decreased exercise tolerance
No chest pain, SOB, cough, leg swelling, weakness.  No focal symptoms. Denies depression.

PE:

Elderly man NAD. BP 160/92. HR 76. RR 16. T 36.4
HEENT: PERLA, EOM normal, OP normal, TM normal. No carotid bruit. No LAD. Thyroid normal
Chest: Clear
CVS: RRR no RMG
Abd: Normal. No mass or HSM
Extrem: No edema. Decreased sensation to mid-calf in bilat lower extremities on microfilament testing.
PPP. Good cap refill. No skin breakdown.
Skin: multiple seb Ks. Few cherry angioma. No suspicious lesions.

Assessment:

  1. Increased fatigue without chest pain
  2. HTN suboptimally controlled on lisinopril 10 mg,
  3. Diabetes with retinopathy, neuropathy, nephropathy on metformin SR 2000 mg bid
  4. Hyperlipidemia on lipitor 10
  5. CHF on lisinopril and lasix 20 mg
  6. Colon ca screening UTD, pneumovax and flu shot UTD, takes baby asa

Plan:

  1. Echo to r/o worsening CHF
  2. Increase lisinopril to 20 mg daily
  3. Zostavax
  4. Vhemistry, cbc, HgA1c, lipid profile
  5. f/u 1 month


Once you have obtained a focused history and exam, you are to make recommendations to the patient, leave the room, and complete an on-line evaluation.

 

 PLEASE DO NOT WRITE ON THIS PAGE

 

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Open Patient
Chart

Patient Chart^

 

Temp   37.1                      BP       110/80                    HR      72                 

Patient Name              John  Harrison                         Patient Age                 80     

History Number  022557                            Chart Number             086254                   

RR       18                    HT                               WT      91.5 Kg        

Complaint:      2 recent falls  and feels less robust than normal.                 

Nurse’s signature        Diane Walters                          

 Copied                                    Dictated

 

Reviewed w/attending

 

_____________________________________________________________________________________

Open SP
Checklist

John Harrison 80 y.o.

Standardized Patient Checklist^

 

Your Name ______________________ Resident Name _____________________

 

GLOBAL RATING

  1. John Harrison was satisfied with this resident physician encounter.     YES        NO

COMMENTS:

Your response to this item should be as “John Harrison” would respond – NOT as you, the standardized patient, would respond, knowing what the resident is being tested on in the checklist.

 YES

  •  You feel you would come back to this resident for the rest of your care.
  • You feel this resident was helpful OR will be able to help you (in your total care).

 NO

  • You feel anything in the encounter with the resident would negatively impact Mr. Harrison significantly enough to cause him to consider seeing someone else for his care.

Your response on this item might not add up to the responses you will make on all of the other items on the checklist. That is fine. This item is included so that you can make a global assessment based on your own feelings about the encounter.

 In addition, please keep in mind that these are residents who are still in training, NOT seasoned physicians. You should not be comparing their performance to your previous experiences with practicing physicians.

 

HISTORY

***General principle in dealing with MULTIPLE QUESTIONS buried in a single resident question:

Example:  Do you drink alcohol or do you do any drugs?

  • Answer only the LAST question asked.
  • Give credit on the checklist for ONLY the questions you answer.

Please record how the resident elicited the following information:

  1.  The resident asked about general well-being and recent health. (“Fine – I think I am doing pretty well, except for this feeling off balance.)

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY:        The resident asked something like: “How have you been feeling lately?”

DONE INCORRECTLY:   The resident used a closed ended question such as “So, you are doing fine, are you?” or s/he asked how you are but didn’t give you time to answer.

  1.  The resident asked about whether I am taking my medications regularly. (“I expect so – My wife sees to it.”)         

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY:        The resident asked about whether you are taking your medications.

DONE INCORRECTLY:   The resident asked whether you take your medications, but did not specify if you are doing it regularly or how often you miss your medications.

  1.  The resident asked about whether I am taking other medicines, over the counter medicines, or any natural supplements. (“No, I only take what the doctor prescribes.”)

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY:        The resident asked whether you are taking any other medicines AND asked whether you are using over-the-counter medicines AND asked whether you take any vitamins or supplements.

DONE INCORRECTLY:   The resident asked if you are taking any other medicines OR over-the-counter medicines OR vitamins or supplements, but not all three categories.

  1. The resident asked, “How has your blood sugar been?” OR “If you have been checking your sugars, what have they been running?” (“I guess I would have to ask my wife – She takes notes about everything. I know she said they were a little high since I have put on this extra weight.”)

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY:        The resident asked if you check your blood sugar at home AND if you answered (“Yes.”), the resident pursued and asked you what your results tend to be.

DONE INCORRECTLY:   The resident asked about blood sugar or blood pressure but did not ask what the values are.

  1. The resident asked about loss of consciousness OR about passing out. (“No.” to any or all of these)

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY:        The resident asked if you have ever recently lost consciousness AND if you answered (“No.”), the resident pursued and asked if you have felt as if you were going to lose consciousness.

DONE INCORRECTLY:  The resident asked if you have lost consciousness but did not pursue any further.

  1. The resident asked about orthostatic dizziness (feeling like you are going to faint upon standing). (“Yes, just since the blood pressure medicine dose was increased.)

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY:        The resident asked about symptoms of orthostatic dizziness. “Do you ever feel like you are going to faint upon standing?”

DONE INCORRECTLY:   The resident asked about symptoms of orthostatic dizziness but did not help you understand what these symptoms might be.

  1.  The resident asked about headache. (“No.”)           

 DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY:        The resident asked if you have been having headaches since you have been having your other symptoms.

DONE INCORRECTLY:   The resident asked if you have ever had headaches but did not focus on the symptoms you came in with.

  1. The resident asked about any head trauma recently or with the falls (“No.”)

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY:        The resident asked you if you have bumped OR hit your head recently OR with any of your falls.

DONE INCORRECTLY:   The resident asked you if have ever had head trauma without explaining what constitutes trauma.

  1. The resident asked about chest pain OR shortness of breath. (“No chest pain. I do get worn out by walking any distance, but this is not really different from before. Seems to be a little better since you gave me that water pill.”)

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY:        The resident asked you if you are having any chest pain OR chest tightness OR shortness of breath at rest OR with exertion OR if you ever have to stop what you are doing because of chest pain or shortness of breath.

DONE INCORRECTLY:  The resident asked if you have chest pain or shortness of breath but didn’t help you describe it.

  1. The resident asked about visual changes. (“I think my vision is okay. I just saw the eye doctor last week. 20/30 in both eyes with my glasses.”)

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY:        The resident asked you about visual changes and, when you answered that you recently saw the eye doctor, the resident asked if you have had any changes since then AND if your vision problem interferes with your reading or other daily activities.

DONE INCORRECTLY:   The resident asked only if you have any vision problems and did not follow up on details.

  1. The resident asked about any numbness or weakness. (“I suppose my feet are a bit numb – and they burn.  I am not as strong as I once was, so maybe I am a little weaker than usual.”)

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY:        The resident asked you if you are having any numbness or weakness AND then follows up your answer with questions to determine if the numbness is peripheral or dermatomal AND to determine if it is worsening. The resident may have also asked questions to determine whether you have any focal or generalized neuropathy.

DONE INCORRECTLY:  The resident asked you about numbness or weakness but didn’t help you by explaining what these words mean.

  1. The resident asked about whether or not you have urinary incontinence or trouble controlling your urine. (“No.”)

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY:        The resident asked you if you have any difficulty with urinary incontinence OR leaking urine OR have to wear a pad in case you lose your urine unintentionally.

DONE INCORRECTLY:   The resident asked you if you have urinary incontinence but did not help you understand the term.

  1. The resident asked about my beliefs, ideas, feelings or expectations about my balance problem. (“It is important for me to remain independent. I think it is important to take medication as prescribed to prevent disease complications, but I am not sure it is worth it because it keeps me from walking.”)

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY:        The resident asked you questions that explored your ideas and feelings about what is wrong and the effect of your balance on your function or daily life.

DONE INCORRECTLY:   The resident did not seek to understand your beliefs, etc. about your balance trouble.


PHYSICAL EXAMINATION

  1. The resident listened to my heart.

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY:        The resident listened to your heart in 4 places with both sides of stethoscope AND listened under (not through) clothing.

DONE INCORRECTLY:   The resident listened to fewer than 4 places OR listened through clothing OR did not listen with both sides of stethoscope (bell and diaphragm).

  1. The resident listened to my lungs.

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY:        The resident listened to your back in 6 places with stethoscope AND listened under (not through) your clothing.

DONE INCORRECTLY:  The resident listened to your back with stethoscope BUT listened in fewer than 4 places OR listened through clothing.

  1. The resident checked vibration sense of my feet.

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY:        The resident instructed you to tell him/her if your felt vibration with the application of the tuning fork AND the resident used a 126 Hz tuning fork AND the resident assessed vibratory sense of PIP joint of great toe (bending joint of big toe) AND the resident checked both feet.

DONE INCORRECTLY:   The resident did not give instruction prior to test OR the resident used 512 Hz tuning fork OR the resident tested the 1st MTP joint (bunion bump) OR the resident only checked 1 foot.

  1. The resident assessed proprioception in my feet.

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY:        The resident instructed you that s/he was going to move your toe and that you were to say whether the toe was being moved up or down AND the resident held your other toes out of the way while testing AND the resident gripped the toe being tested on medial and lateral aspect.

DONE INCORRECTLY:   The resident did not give instruction prior to test OR the resident did not hold other toes out of the way OR the resident gripped the toe being tested on dorsal and plantar aspect.

  1. The resident assessed my gait and balance

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY:        The resident asked you to rise from a chair without using your arms AND to stand still for a minute AND to walk, turn around, and walk back to the chair. AND s/he asked you to stand in front of the chair AND asked you to stand with your feet together, arms out front with palms up AND then asked you to close your eyes AND then to relax AND the resident gave you three gentle nudges on the chest AND the resident asked you to sit down. During these maneuvers, the resident watched you walk AND stood close by in case you started to fall.

DONE INCORRECTLY:   The resident asked you to get out of the chair but did not mention your arms OR the resident asked you to walk but was not standing close enough to steady you if you needed it OR had you stand but not walk OR the resident asked you to stand with your feet together and eyes closed without seeing if you could do it with your eyes open OR didn’t explain what s/he was going to do OR didn’t make sure the chair was behind you when s/he gave the gentle sternal nudge OR didn’t ask you to sit down.


PATIENT-PHYSICIAN INTERACTION

  1. The resident introduced him/herself to me.

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY:        The resident told you their LAST name AND that they are a resident physician.

DONE INCORRECTLY:   The resident ONLY told you that s/he is a resident OR that s/he was asked to come and see you.

  1. The resident accommodated my hearing difficulty.

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY:        The resident recognized your hearing difficulty and adapted by speaking more slowly, in a lower pitch, slightly louder and by directly facing you when speaking AND by confirming that you were able to hear or comprehend with these changes OR s/he offered you his/her stethoscope and spoke into the bell AND confirmed that you were able to hear.

DONE INCORRECTLY:   The resident spoke louder or made accommodation for your hearing difficulty but did not confirm that you could hear with his/her adjustments.

NOT DONE:    The resident did not recognize hearing difficulty OR recognized but did not make accommodation for hearing difficulty.

  1. The resident behaved warmly, but professionally throughout the entire encounter.

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY:        The resident respectfully demonstrated genuine care and concern.

DONE INCORRECTLY:   The resident demonstrated genuine care and concern, but was overly familiar or personal with you.

NOT DONE:    The resident was cold and distant OR condescending OR overly informal and chummy.

  1.  The resident used words I could understand.

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY:    You (as the patient) understood all the terms.

DONE INCORRECTLY:   More than two terms were unfamiliar to you.

NOT DONE:    Pretty much everything the resident said to you was in “medical-speak.”

  1. The resident encouraged me to ask questions and never avoided giving me an answer.

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY:     The resident specifically asked if you had questions AND answered them directly or promised to get the answer for you.

DONE INCORRECTLY:   The resident did not specifically ask you if you had questions, but gave you the impression that you could ask questions and that you would get a direct answer.

NOT DONE:      The resident never asked if you had any questions and gave you the impression of not being open to questions OR avoided giving answers to anything you asked.