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  #1  
Old 06-19-2011
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Question Counseling during history taking not waiting to the end of the encounter

hey,

I have to ask about counseling. I have an exam soon and I have gone over the practices a couple of times now. I have been counseling there and then about smoking, alcohol and drugs. I learned it from CSE videos. I have been told by a couple of friends to counsel in the end. Is it ok to counsel there and then or would it look like judgmental?
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  #2  
Old 06-20-2011
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Is it ok to counsel there and then or would it look like judgmental?
Did not understand your question..

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Old 06-20-2011
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I mean when we ask about smoking, and alcohol or sexual history, can we counsel at that time or wait till the closure?
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Old 06-20-2011
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Originally Posted by muntasha View Post
I mean when we ask about smoking, and alcohol or sexual history, can we counsel at that time or wait till the closure?
Yes, you can do it but it's recommended that you leave it to the closure part of your encounter.
This is because the SP is trained to mark your performance by phases and stages, so if you don't counsel him/her about it during the closure part and instead do it during the history taking then he/she might forgot to check you out in that regard.

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Old 06-20-2011
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Another question for counseling, If we have a patient who drinks, smokes, drugs...(he has many things to counsel). Can I say smoking &...etc harm your life & you should quit them? or I have to counsel for each one separately!!??
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Old 06-20-2011
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Quote:
Originally Posted by good_boy_1234 View Post
Another question for counseling, If we have a patient who drinks, smokes, drugs...(he has many things to counsel). Can I say smoking &...etc harm your life & you should quit them? or I have to counsel for each one separately!!??
Of course you have to counsel each one of them separately. Never say ..etc to the SP and never list stuff together.

Remember, that the SP might be willing to stop drugs for example but at the same time might think that his drinking/smoking behavior is not abnormal and he's happy with it, so this is another reason that you have to counsel each separately.

Likewise, never say for example, do you have cough, chest pain, heart pain? the SP will be pissed off by such a question. You should ask one question at a time and wait for the SP to answer.

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Old 06-20-2011
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Quote:
Originally Posted by Sabio View Post
Yes, you can do it but it's recommended that you leave it to the closure part of your encounter.
This is because the SP is trained to mark your performance by phases and stages, so if you don't counsel him/her about it during the closure part and instead do it during the history taking then he/she might forgot to check you out in that regard.

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From watching CSEvideo, I've learned to counsel right after the patient says he smokes a lot or drinks a lot,..etc. It helps you avoid forgetting to counsel and it seems logical to immediately counsel. I was in a office today, and the doctor did the same. However, since you said the SP may forget I counseled, I think I'll have to do it in the closure . I'm personally concerned about the SP's way of assessment; I wish they had the checklist with them during the encounter to not forget anything!
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Originally Posted by Haisook View Post
From watching CSEvideo, I've learned to counsel right after the patient says he smokes a lot or drinks a lot,..etc. It helps you avoid forgetting to counsel and it seems logical to immediately counsel. I was in a office today, and the doctor did the same. However, since you said the SP may forget I counseled, I think I'll have to do it in the closure . I'm personally concerned about the SP's way of assessment; I wish they had the checklist with them during the encounter to not forget anything!
They do have the checklist with them, they pull out their laptop right after you leave the room.
You know what, let me change my opinion here. I think it's fine doing it by both ways. I think they'll remember it even if you counsel during history taking.

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I think that doing it the way it is done in CSE videos is good because the issue has been taken care of at the spot. In the closure there are so many other things to talk about and there is a high chance that the sp might forget that we counseled or not. Although in any case it is fine.
Then do you recommend I continue with counseling during the history?
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Then do you recommend I continue with counseling during the history?
Yes, both ways are fine. Just do whatever you feel comfortable with.

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Thanks for answering...regarding counselling for smoking as an example...is it fine that just tell the patient that smoking harms your health & I highly recommend to quit smoking?
Because the counselling in FA is long: first to tell about the problems of smoking then offer stop smoking then to talk about that we have many programs & it is better to schedule second appointment.......etc
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Quote:
Originally Posted by good_boy_1234 View Post
Thanks for answering...regarding counselling for smoking as an example...is it fine that just tell the patient that smoking harms your health & I highly recommend to quit smoking?
Because the counseling in FA is long: first to tell about the problems of smoking then offer stop smoking then to talk about that we have many programs & it is better to schedule second appointment.......etc
First ask the SP whether he/she wants to quit "Have you ever thought of quitting smoking" according to the SP answer the scenario varies.

Sometimes they say "why should I quit?" you then have to explain the health risks of smoking.

Sometimes they say "No, am OK with it, I like it and I don't want to quit" you then avoid the whole counseling issue and move on to the next question.

Sometimes they say "Yes, I want to stop" or "I can't stop" or "I wish to stop" ....etc you then have to say, "OK, am here to help you. I will ask the nurse to provide you a brochure with our excellent smoking cessation program and I will schedule you for an appointment to help you with that".

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Old 06-21-2011
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You can do it both ways... from myexperience u will not usually remember all the positives u have to counsel about at the closure. So do it after better than totally to forget to. Or keep like a space in the top and write in it whatever during the hx u find u need to counsel about in the closure so u dont mess it. good luck!
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