Behavioral Science

Clinical Practice and Difficult Situations 179
Which of the steps above is most likely
to be asked on the USMLE?
How do you use an interpreter?
Is it OK to allow a child or family
member to act as an interpreter?
What is patient adherence (formerly
called “compliance”)?
What are barriers to patient adherence?
How might a physician make a
treatment plan less complicated?
What is an open-ended question?
What is a close-ended question?
Finding out how much the patient
knows about their illness (no 2). It’s
always good to get information first so
you can frame the discussion.
Speak to the patient, not the interpreter.
Speak clearly, being sure to pause
intermittently to allow the interpreter
to convey information to the patient.
No, not if it can be helped. Even if the
family member is fluent, it is good to at
least offer to get an interpreter for the
patient. Family members may also have
their own agenda that may unduly
influence the patient.
The degree to which the patient follows
the advice of the treating physician
Complicated medical regimens
Poor physician-patient rapport
Lack of patient involvement in the
treatment plan
Infrequent appointments
Poor support structure/inadequate help
at home
The treatment plan can be simplified by
limiting:
• The number of medications the
patient is taking
• The number of times the medications
is taken per day
• The number of changes made at each
visit
A question that is intentionally left
broad, such that the patient can say
what is really on their mind—“What
brings you into the clinic today?” or
“Tell me about your stomach pain.”
A very specific question with a discrete
answer. Used to get more detail—
“Did you have nausea?” “How
frequently do you have pain?”
This is also useful with seductive
or disorganized patients.