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why not to direct on hospitalization. In most cases he can complain of treatment,
medications or nurses without speaking directly that he wants to hospital. Open
and special questions help with such kind of cases.
Questions –
the difficult patients’ problems need to be set and differentiate.
Questions show that the doctor is not only hearing you, but he is also listening; he
is ready to help. Questions should be set directly and clearly. By asking it is
necessary to listen and to write down key words. The patient should be sure in
avoiding asking the same question two or more times[25]. Noticing of such kind of
things can show them incompetence of the doctor. And in the end of the
consultation the doctor can read out his notes and make sure that everything is
written correct. For example, «you have a headache, feel weariness and it is
proceeding three months. All of these you’re connecting with death of your father.
You have symptoms as a diarrhea, cough or ulcers on a skin». If open questions
help to define a problem, fears, experiences of the patient, special and alternative
questions help to specify the diagnosis and to define tactics. Patients cannot define
which of symptoms basic, key and they stoke on symptoms which are important
for them. The child has fever, has no appetite but parents are complaining of
sleepless nights and he is not giving them time to have a rest. Or another situation,
the child with a chronic diarrhea is losing water but it is not disturbing his parents,
they explain it with coming up his teeth and consequently do not consider
necessity of telling to the doctor. In such cases a question «Does your child have
normal stool? » can not be correct, and there is need to ask in more details «How
many times is the child having a stool and of what consistence?». Questions should
be set one by one and give time to think and to answer.
Patients can sometimes lie specially and in most cases without having any reason
for it. There can be questions concerning alcohol, diets, playing sports or recover.
In such cases the doctor should make conclusion himself. If the question is very
important for diagnostics and treatment tactics there is possibility to formulate so
that a question could become clear as much as possible and objective, for example,
in spite of «How are you feeling today? » it may be asked «How many times did
you have fewer today? What about yesterday? » or «Is right hand’s pain disturbing
you less or more? ». Despite that patients often have some mistakes at the
assumption of disease and it’s the reason why these assumptions are very
important.
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