1. Dr. Abdelmonem Gado, MS Surgery, FRCSI Consultant Paediatric Surgeon, Division of Paediatric Surgery, Department of Surgery

2. Your professional obligations, the expectation placed upon you by the public, the law and your colleagues, start on your first day as a student and continue throughout your working life.

3. The qualities that patients look for in a doctor: Humaneness Competence Accuracy Honesty Openness Responsiveness Trusthworthiness Involving the patient in the decision making process Time and listen

4. -Language: - Learn to speed read - A good clinician is someone who interested in people - Put yourself in situation of the patient or their relatives - The best doctor are invariably the most humble and - good observer - Dress, Demeanour and confidentiality to establish successful patient – doctor relationship

5. Set-up: - Where will you see your patient? - Keep always quite and private space - How long this interview? - How will you sit? Hand washing and Cleanliness: - Is the single most effective way to prevent the spread of infection

6. Infections that can be transmitted on the hands of healthcare workers” - Healthcare – acquired infections: -MRSA- Clostridium difficile -Diarrheal infection: -Salmonella - Shigella- E.coli - Noro virus -Respiratory Infection: -Influenza - Common cold - Resp. Syncytial virus (RSV) -Other Infections: Hepatitis A

7. Communication Skills, How? - Maintain good eye contact - Active listening, then write - Encourage verbal or non verbal communication - Avoiding jargon - Ability to discuss difficult issues - Going at a place that is comfortable for the patient - Diligent and frequent practice

8. Introduce yourself: - I am Mr…., I am 3 rd year medical student - I have been asked to talk to you and examine you with some of my colleagues - It might take 30 minutes - Privacy - Notes (it does not mean I’m not listening to you - Are you happy with all that?

9. Things to remember: - Never write while talking - See the patient walking - See the accompanying person (mother, wife, friend) -Can often provide valuable information -However, many patients are inhibited from discussing their problems by the presence of third person

10. Guide the conversation: - Explain what you are doing, and why you are doing it, at all stages - patients know more about their complaints than you, but cannot interpret their significance: - Interpreter – short and simple questions - Leading questions - one answer - open questions - Example : Does the pain ever move? - Always ask the questions in the right way.

11. Principle of History taking in Surgery: History taking ? the key step in surgical diagnosis. Varies according to the complain ? specific histories ? surgical specialty

12. Out-pt or emergency room history ?specific complaint is pinpointed ? diagnosis Clerking of pt admitted for elective surgery object ? to assess that the treatment planned correctly indicated and pt is suitable for that operation.

13. Information gathered during patient interview

14. - Date and Time- Chief Complaint - Identifying data- Present illness - Source of referral- Past medical and surgical history - Source of history- Family History - Social History - Drug History

15. I. Personal Information - Age, Sex, marital status, occupation nationality, residence, etc..

16.  HISTORY cont..: 2) Present complain: - open question - closed question - write in patients words

17. Symptoms that caused patient to seek care Often: Pain Abnormal function Change in normal state Unusual observation made by patient (e.g., heart palpitations)

18. 3) History of present illness (Complaint) - Provide full, clear, chronological account of symptoms - In scientific term - Similar attacks - Determine the abnormal system

19. HISTORY cont..: 4) Remaining question of abnormal system

20. HISTORY cont.: 5) Systemic direct question: ◦ it reveals the presence of other disorders of which the patient was unaware, or thought irrelevant ◦ -ve answers are as important as +ve answers

21. Appetite- Heartburn Diet- Vomiting Weight- Haematemesis Teeth and Taste- Indigestion Swallowing- Abdominal pain Regurgitation- Defecation Flatulence- Change of skin Color

22. - Cough - Sputum - Haemoptysis - Dyspnea - Orthopnea - Chest pain

23. - Breathlessness - Orthopnea - Paroxy swal noctural dyspnea - Pain - Palpitations - Cough and sputum - Dizziness and headaches - Ankle swelling

24. - Pain- Scrotum & urethra - Oedema- Menstruation - Thirst- Dyspareunia - Micturation- Breast - Urine –haematuria- Secondary sex character

25.  Nervous system and musculoskeletal system

26.  General state of health: ◦ Childhood illnesses ◦ Adult illnesses ◦ Accident and injuries ◦ Surgeries or hospitalizations

27.  Health of immediate family ◦ High blood pressure, heart disease, contagious illnesses  Potential for hereditary diseases

28.  Marital status  Occupation  Residency  The lesiure activities  Habits (smoking, alcohol,etc)  Travelled abroad.

29.  Alcohol or drug use  Physical abuse or violence  Sexual issues

30.  Respect patient privacy  Be direct and firm  Avoid confrontation  Be nonjudgmental  Use appropriate language  Document carefully ◦ Use patient’s words when possible

31.  Silence  Overly talkative patients  Patients with multiple symptoms  Anxious patients

32.  Anger and hostility  Intoxication  Crying  Depression  Sexually attractive or seductive patients  Confusing behavior or histories  Limited intelligence  Developmental disabilities

33.  May result from: ◦ Social or cultural differences ◦ Sight, speech, or hearing impairments  Attempt to find assistance to aid in communication

34.  Pain  Lump

35.  History of pain -The site -Onset -Duration -Severity -Nature of the pain -Progression of the pain -Relieving and exacerbation factors -Radiation and refering pain

36.  History of a lump -Site. -Duration. -What made the patient notice the lump. -course of the lump. -Associated symptoms. -Other lumps

37.  QUIZ

38.  QUESTIONS?

39.  THANK YOU!