1st attempt: CS fail in the CIS component.
2nd attempt 1 month later: all three areas are high performance 星星在最右边.
patient panicking ( I can’t breathe, etc) (Hi Ms, are you OK? can you come and sit on the exam table, would that be more comfortable for you?) (one thing we can do is to take a deep breath, can you follow me, breath in and out slowly like this, in and out, in and out).
patient is suicidal. “Mr X, I would like you to stay in the hospital for the time being so that I can run some tests. would that be Ok?”
patient crying ( give tissues. Do you need tissues? Mrs--, I am here to help you. Can you tell me what’s bothering you?)
Patient doesn't engage/acts weird/has an attitude. "Mr/Ms X, it seems you are concerned about something. Would you like to share it with me?"
“I am a bad person/mother” ( No Mrs X, I don’t think you are a bad person, it is a difficult situation and you did the best anyone could have done).
Did I come in too late? (Mr, I am glad that you are here. I want to help you and it is never too late.)
Lights bothers me. can you not do this? (Mrxxx, it is important for me to look into your eyes to understand better about your condition. I will be as brief as possible. Is that Ok?)
Cancer talk: don't mention cancer if possible if you have to do it: “one possibility is that this could also be cancer. I know this is very scary, but I do feel this is something we have to rule out. That’s why I am going to get some tests and imaging studies to figure out what’s going on. Regardless of what this is, I am going to be here with you every step of the way.”
Do you think this is X (a terminal dz like parkinson’s disease) (asked while still in the HPI, you want to defer). “ Mr, X, I understand your concern. this is a possibility, but there are many conditions could also cause XYZ. I just want to ask you a few more questions to make sure we don’t miss anything and talk about what this might be in the end. is that OK with you?”
Can you give me something for pain right now? (Mr XY, I can see that you are in a lot of pain right now. Depends on the causes of your pain, there are different pain medications that work the best. I would like to ask you a few more questions to make sure we know what’s going on, then give you something for pain at the end. Is that ok with you?)
Can she still eat sweets (mother with a daughter who has diabetes)? (Make it more uplifting.) “I understand your concern. Diabetes does it make it challenging for she to eat the sweets that she enjoys. But the good news is (be excited and smiling) she can still eat them, just in smaller amounts.”
counsel a 75 year old who don’t want to quit smoking because he is too old (Mr. X, I understand where you are coming from. But smoking can causes many harms to your body, especially to your heart and lungs. you will notice the difference soon after you quit smoking. it is never too late to quit.)
strong emotion towards cancer diagnosis “I just was told about cancer, how am I supposed to feel?!” Answer: I understand your are frustrated. Anyone in your situation would feel upset. I want to assure you that we are here with you every step of the way, and we are going to work together with you to find the best treatment for you.
"My car was totaled in the car accident". “That must be a terrible experience for you. let me make sure there is nothing serious going on with your health so that you can put this behind you soon”
“Maybe I will give my baby up for adoption” a young mother has an unplanned pregnancy. answer: whatever decision you make, we will help you.
“how many partners do you have?” “just my husband, I am faithful” “ I don’t mean it that way, I really apologize if this offended you”
you: How may I help you? I don’t think you can help me. “ Mr. XY, I understand it must be a difficult time for you. Can you tell me whats going on?
patient: I don’t want to talk about it (sex or smoking etc).
you: ‘ Mr XX, I didn’t mean to pry. These are just questions I ask every
patient of mine to make sure we don’t miss anything.”
Patient: “again I just don’t feel comfortable”
You: “are there anything in particular that concerns you?” (open-ended questions)
If run of out time “I will be in touch once we have all the test results. I know it is difficult for you. Hang in there”
"I don’t think the treatment is going to do anything. I’ve already tried everything" “I understand you have been through a lot. but we are not going to give up and I don’t want you to give up”
"Can I still go to the trip and then do the tests” “ Mr. I understand your concern. I can see how excited you are about this trip. it doesn’t sound as though you are well enough for this trip. How about we do some initial tests and see how you are feeling, then decide whether we are comfortable letting you go away?